title: Fibrinopeptide A in liver cirrhosis: evidence against a major contribution of disseminated intravascular coagulation to coagulopathy of chronic liver disease.
abstract: To test the hypothesis that disseminated intravascular coagulation contributes to hemostatic failure in liver cirrhosis, fibrinopeptide A and fibrin(ogen) degradation fragment E were measured in 69 patients with stable liver cirrhosis and compared with fibrinopeptide A and fibrin(ogen) degradation fragment E in 32 healthy subjects, 33 patients with thromboembolism, and 10 patients with hypofibrinogenemic disseminated intravascular coagulation. Mean fibrinopeptide A in cirrhosis was slightly increased compared with healthy subjects (2.4 vs. 1.8 ng/ml, p < 0.005), but fourfold lower than in thromboembolism (mean fibrinopeptide A 9.7 ng/ml; p < 0.0001), and tenfold lower than in disseminated intravascular coagulation (mean FPA 24.3 ng/ml; p < 0.0001). Single fibrinopeptide A levels in cirrhosis were within the normal range in 75% of the patients, marginally increased in 9%, and definitely increased in 16%. A definite increase in both fibrinopeptide A and fibrin(ogen) degradation fragment E, which characterized the groups of patients with thromboembolism and disseminated intravascular coagulation, was found in 10% of the cirrhotic patients. Among 17 patients with cirrhosis and hypofibrinogenemia, mean fibrinopeptide A (2.7 ng/ml) was tenfold lower compared with mean fibrinopeptide A in patients with hypofibrinogenemic disseminated intravascular coagulation (p < 0.0001), whereas the frequency of increased single fibrinopeptide A levels (29%) was not significantly different compared with the 52 cirrhotic patients without hypofibrinogenemia (single levels elevated in 23% of the cases). Moreover, the frequency of hypofibrinogenemia, thrombocytopenia, or abnormal clotting times was not significantly different in cirrhotic patients with normal fibrinopeptide A level when compared with cirrhotic patients with increased fibrinopeptide A. These findings do not support an important contribution of disseminated intravascular coagulation to coagulopathy of liver cirrhosis.
authors.affiliation: Ospedale La Carità, Locarno, Switzerland.
authors.forename: G
authors.initials: G
authors.lastname: Mombelli
authors.forename: G
authors.initials: G
authors.lastname: Fiori
authors.forename: R
authors.initials: R
authors.lastname: Monotti
authors.forename: A
authors.initials: A
authors.lastname: Haeberli
authors.forename: P W
authors.initials: PW
authors.lastname: Straub
mesh_terms: D000328:Adult; D000368:Aged; D001778:Blood Coagulation Disorders / Q000209:etiology*; D001780:Blood Coagulation Tests; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000150:complications*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005344:Fibrinopeptide A / Q000032:analysis*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D013923:Thromboembolism / Q000097:blood
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C018543:fibrinogen fragment E; D005344:Fibrinopeptide A