title: Hyperfibrinolysis resulting from clotting activation in patients with different degrees of cirrhosis. The CALC Group. Coagulation Abnormalities in Liver Cirrhosis.
abstract: This study explored the relationship between clotting activation and tissue plasminogen activator and its inhibitor in cirrhotic patients with different degrees of liver failure. Sixty-seven patients (40 men, 27 women; age = 31-77 yr) with cirrhosis diagnosed by liver biopsy were divided into three subgroups (A, B and C) on the basis of Child-Pugh classification. Tissue plasminogen activator antigen and activity, plasminogen activator inhibitor antigen and activity, fibrin/fibrinogen degradation products, and D-dimer were measured in each patient. Forty-two patients with normal levels of fibrin/fibrinogen degradation products and D-dimer showed significant progressive decreases of plasminogen activator inhibitor antigen levels (p < 0.01) and activity (p < 0.0001) from class A to class C. This decrease was significantly related to prothrombin time (p < 0.003). Tissue plasminogen activator values were not different in the three Child classes. Twenty-five patients (7 class B and 18 class C) with high circulating values of fibrin/fibrinogen degradation products and D-dimer had higher values of tissue plasminogen activator antigen (20.0 +/- 10.1 ng/ml vs. 5.9 +/- 3.0 ng/ml; p < 0.0001) and activity (6.9 +/- 2.2 U/ml vs. 2.1 +/- 1.3 U/ml; p < 0.0001) and lower values of plasminogen activator inhibitor antigen (6.9 +/- 4.1 ng/ml vs. 14.8 +/- 5.6 ng/ml; p < 0.0001) and activity (4.1 +/- 2.8 U/ml vs. 9.8 +/- 3.7 U/ml; p < 0.0001) than did patients with normal values of fibrin/fibrinogen degradation products and D-dimer.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Istituto di I Clinica Medica, Universitá La Sapienza Policlinico Umberto I, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Violi
authors.forename: D
authors.initials: D
authors.lastname: Ferro
authors.forename: S
authors.initials: S
authors.lastname: Basili
authors.forename: C
authors.initials: C
authors.lastname: Quintarelli
authors.forename: A
authors.initials: A
authors.lastname: Musca
authors.forename: C
authors.initials: C
authors.lastname: Cordova
authors.forename: F
authors.initials: F
authors.lastname: Balsano
mesh_terms: D000328:Adult; D000368:Aged; D001777:Blood Coagulation; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications; D017093:Liver Failure / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015849:Plasminogen Inactivators / Q000097:blood; D012044:Regression Analysis; D010959:Tissue Plasminogen Activator / Q000097:blood
chemical_list: D015849:Plasminogen Inactivators; D010959:Tissue Plasminogen Activator