Fibrinolytic study in plasma and ascitic fluid of cirrhotic patients before and after ascites concentration; reinfusion technique

Abstract

Management of cirrhosis with massive ascites involves particular difficulties. The introduction of a peritoneovenous shunt and reinfusion of concentrated ascitic fluid techniques allows increased diuresis and improves renal function. However, these procedures have frequently been associated with disseminated intravascular coagulation and/or activation of fibrinolysis. Factor VIII activity, antigen and ristocetin cofactor, plasminogen, antiplasmin, plasminogen activator activity and plasmin-antiplasmin complex were investigated both in the ascitic fluid and plasma of cirrhotic patients before and after the concentration-reinfusion technique. Our results indicated that no hyperfibrinolysis was seen in the plasma of cirrhotic patients and that activation of fibrinolysis exists in ascites. Significantly higher levels of plasmin-antiplasmin complex and plasminogen activator activity were found in ascitic fluid than in plasma. In post-reinfusion much higher levels of all three Factor VIII components were observed in cirrhotic plasma than in normal plasma. In conclusion, activation of fibrinolysis could explain coagulation complications occurring after ascites reinfusion. Antifibrinolytic treatment could render the concentration-reinfusion technique more acceptable.

Fibrinolytic Behavior in Long-Standing Branch Retinal Vein Occlusion

“…More over a significant shortening of PTT was found in our patients. This could be due to an increase of factor VIII seen in RVO pa tients, as previously reported by others [8,9,16]. In spite of an ELT prolongation mani fest in few patients, a significant reduction in fibrinolytic activity was not detected in our patients, totally considered, as compared to normal controls.…”

“…Fibrinogen levels were obtained according to a modification of the Ratnoff method as proposed by Girolami et al [3]. Plasminogen, AT III, < X 2-antiplasmin and aimacroglobulin activities were assayed using chromogcnic substrates as previously described [9,10].…”

A DIC-like picture on plasma and ascitic fluid of cirrhotic patients

“…In a previous work we demonstrated an hyperfibrinolysis state in ascites and higher fibrinolytic activity in the plasma after the reinfusion procedure [12]. The aim of this study was to (1) demonstrate a DIC picture in the ascitic fluid and (2) confirm that the coagulopathy shown after reinfusion is subsequent to infusion of a large amount of fibrin degradation products.…”

“…The diagnosis was confirmed by liver biopsy. All subjects had intractable ascites and were treated with the reinfusion of ultrafiltrated ascitic fluid, as described previously [12], over a continuous period from 7 to 30 h (mean: 12.8 h).…”

“…The presence of DIC in this disease is not uni-* Supported by grants (nos. 1952 and 1986) from MPI, Rome, and the Venetian Government, Venice, Italy Offprint requests to: Dr. G. M. Patrassi versally accepted [3,12,20]. Management of patients with massive ascites involves particular difficulties.…”