Metabolism of Fibrinogen in Cirrhosis of the Liver

Abstract

A B S T R A C T The metabolism of human fibrinogen labeled with radioactive iodine was studied in 50 patients with documented cirrhosis of the liver and in 35 healthy control subjects. Results in cirrhotic subjects were the following: plasma volume 47 ±+10 ml/kg; plasma fibrinogen concentration 250 ±102 mg/100 ml; total plasma fibrinogen pool 118 ±59 mg/kg, representing 0.73 +0.10 of the total body pool; fibrinogen half-life 2.99 +0.59 days; fractional catabolic rate 0.34 ±0.09 of the plasma pool per day; absolute catabolic rate 39 ±20 mg/kg per day; fractional transcapillary efflux rate 0.82 ±0.30 of the plasma pool per day. Results in the control subjects were the following: plasma volume 42 ±7 ml/kg; plasma fibrinogen concentration 284 ±71 mg/100 ml; total plasma fibrinogen pool 119 ±40 mg/kg, representing 0.72 +0.07 of the total body pool; fibrinogen half-life 4.14 ±0.56 days; fractional catabolic rate 0.24 ±0.04 of the plasma pool per day; absolute catabolic rate 28 ±9 mg/kg per day; fractional transcapillary efflux rate 0.60 ±0.26 of the plasma pool per day.A significant difference between cirrhotics and controls was observed for plasma volume, fibrinogen halflife, fractional and total catabolic rates, and transcapillary efflux rate. During heparinization of 10 cirrhotic patients the fibrinogen half-life was prolonged from 3.15 ±0.69 to 4.59 ±0.79 days. This was associated with a rise in plasma fibrinogen in six out of eight patients. Heparinization did not influence the fibrinogen half-life in five control subjects. Inhibition of the fibrinolytic system in 17 patients resulted in prolongation of the plasma radioactivity half-life of more than 1 day in only three patients, an incidence comparable with that in five control subjects.These results strongly support the concept of accelerated fibrinogen consumption by a process of disseminated intravascular coagulation in cirrhosis of the liver.

Dysfibrinogenemia Associated with Liver Disease

“…High levels of an R-type B12-binding protein with increased sialic acid content have also been demonstrated in patients with hepatoma (25). In addition, T I ME (min) 30 FIGURE 2 Fibrinopeptide release from purified normal and patient fibrinogens. Fibrinogen concentration was 2.7 mg/ml, thrombin concentration was 1.25 U/ml, and temperature was 25°C.…”

A case of liver cirrhosis complicated with endotoxemia and disseminated intravascular coagulation : A case report.

“…Tytgat et al (1971) showed a shortened fibrinogen half-life in cirrhotic patients using human fibrinogen laleled with radioactive iodine. This finding, however, may support the concept of chronic DIC rather than overt DIC proposed by the Scandinavian authors, because the investigated cases were relatively stable and thought not to be in overt DIC.…”

AICF and DIC in Liver Cirrhosis: Expressions of a Hypercoagulable State

“…Because of the striking similarity between the hemostatic abnormalities seen in liver cirrhosis and those observed in disseminated intravascular coagulation (DIC), also called consumption coagulopathy, there has been a long and continued debate as to whether DIC is a common feature of, and an important contributor to, hemostatic failure in liver cirrhosis (2-6). The notion of a consumptive coagulopathy in liver cirrhosis was supported by earlier observations (7)(8)(9)(10)(11) that survival of radiolabeled platelets, fibrinogen, and plasminogen was shortened in some patients with liver cirrhosis, and, more importantly, shortened survival of fibrinogen, but not that of platelets or plasminogen, could be prolonged with administration of heparin (7-10) and antithrombin III (ATIII) (11).…”