Portal and systemic fibrinolysis in cirrhotic patients and their relation to oesophageal variceal bleeding

ABSTRACT

Disturbed hemostasis is well documented among patients with hepatic cirrhosis. In this work, plasma fibrinolytic activity was evaluated in both portal [variceal] and systemic [venous] blood in patients with cirrhosis, in a trial to investigate its possible relation to bleeding esophageal varices, as well as to the degree of liver cell failure, to find out whether it is locally enhanced in the varices or not. Sixty- three cirrhotic patients were the subjects of this work. Sixteen healthy individuals served as normal controls. BT, platelet count, PT, PTT and fibrinogen level were studied in all systemic blood samples. Plasminogen, t-PA, PAI-1, PAP, FDPs and D-dimers were evaluated in systemic and variceal samples. All parameters were considerably altered in diseased groups. With the exception of PAI-1 the impairment of hemostatic parameters tended to parallel the degree of liver cell failure. Unexpectedly, the hemostatic disturbance was more marked in patients with non bleeding esophageal varices than in those with bleeding varices. Furthermore, all fibrinolytic parameters studied showed insignificant differences between systemic and variceal samples, i.e. There is no evidence of locally enhanced fibrinolysis in the varices