Coagulopathy during ascites reinfusion: prevention by antiplatelet therapy.
The development of disseminated intravascular coagulation (DIC) during a controlled IV infusion of concentrated ascitic fluid was studied in a group of patients with cirrhosis and refractory ascites. Nine studies were performed on patients who had not received prophylactic antiplatelet therapy. All developed laboratory evidence of DIC. The total collagen infused, estimated by ascitic hydroxyproline concentration, correlated significantly with both the prolongation of the partial thromboplastin time with kaolin (r = 0.8628; P less than 0.005) and the decrease in platelet count (r = 0.5674; P less than 0.05). The changes in the coagulation profile were reversible on ceasing the infusion, returning to baseline levels within 12 hours. There were no changes in the coagulation profiles of four patients studied 48 hours after beginning antiplatelet therapy with aspirin and dipyridamole. It is concluded that the infusion of concentrated ascitic fluid into a peripheral vein of patients with cirrhosis results in DIC, the severity of which correlates with the amount of collagen infused and which is completely prevented by inhibiting collagen-induced platelet aggregation. The results support the hypothesis that the DIC that complicates ascites infusion into the systemic circulation is largely related to ascitic fluid collagen.
Tang
H H
HH
Department of Gastroenterology, Monash University, Alfred Hospital, Melbourne, Australia.
Salem
H H
HH
Wood
L J
LJ
Dudley
F J
FJ
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001202:Ascitic Fluid / Q000737:chemistry*; D003094:Collagen / Q000032:analysis / Q000502:physiology*; D004211:Disseminated Intravascular Coagulation / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006909:Hydroxyproline / Q000032:analysis; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*
D010975:Platelet Aggregation Inhibitors; D003094:Collagen; D006909:Hydroxyproline