Improvement Of Plasmatic Coagulation In Patients With Liver Disease To Enable Necessary Diagnostic And Therapeutic Steps

Abstract

Specific plasmatic concentrations of coagulation factors are necessary in endoscopic treatment e.g. slerosis of esophageal varices. Thrombotest of 35 to 40% is necessar. To correct with factor concentrates and fibrinogen is dangerous in cause of pushing DIC (disseminated intravascular coagulation). The substitution of the inhibitor AT III which is succeeded from prothrombin concentrates and fibrinogen avoid fearful consumption reactions. The AT III plasma activity was measured by chromogenic substrates in citric plasma. In 5 patients (2 female, 3 male- age 19-67) the diminished AT III-levels were increased to the normal value of 80%. After normalization of the inhibitors prothrombin complexes and if necessary fibrinogen were substituted. It was seen an assessable improvement of the plasmatic coagulation which depends on the unit concentration of the substituted factors. In the improved coagulation situation 2 laparoscopies and 3 slerosis of esophageal varices could be done without any bleeding complication.Patients with liver diseases and coagulation disorders who were unsuitable for endoscopic and surgical treatment can be treated with this concept.