The hyperfibrinolytic state of liver cirrhosis: possible pathogenetic role of ascites.

We evaluated coagulation and fibrinolytic parameters in both plasma and ascitic fluid of 39 patients with ascites secondary to liver cirrhosis and in 14 cirrhotic patients without ascites, in order to verify if the peritoneal compartment could be involved in the pathogenesis of the hyperfibrinolytic state of the disease. An activation of fibrinolysis, as suggested by increased levels of FDP, D-dimer and tissue plasminogen activator (t-PA) was demonstrated in both ascitic fluid and to a lesser extent in plasma. A positive correlation was also observed between plasma and ascitic fluid plasminogen, anti-plasmin and fibrinogen, while a negative correlation was found between plasma and ascitic fluid plasminogen activator inhibitor-1 (PAI-1). Moreover, plasma PAI-1 was significantly lower in patients with ascites than in those without ascites and among ascitic patients in those who had bleeding into soft tissues when compared to those who did not present haemorrhagic events. Finally, a significant association was also shown between positivity for plasma D-dimer (> 200 ng/ml) and the presence of ascites. Taken together, our data suggest an exchange of some coagulation and fibrinolytic proteins between plasma and ascitic fluid and point out the key role of PAI-1 in regulating plasma fibrinolytic potential and in bleeding complications in cirrhotic patients.

[Various parameters of hemostasis in patients with chronic liver diseases]. / Studio di alcuni parametri dell'emostasi in pazienti con malattie croniche epatiche.

The aim of the study was to investigate the nature and the possible correlations between abnormalities of platelet function and haemostatic and fibrinolytic activity in a group of 33 patients with biopsy-proven chronic liver disease. A slight decrease in prothrombin activity, AT III and plasminogen levels was noticed in the patients studied. Significantly enhanced levels of intraplatelet 5HT was also found in patients with cirrhosis and in those with chronic active hepatitis. Changes in these parameters were generally independent from each other, the only correlation being found between prothrombin activity and AT III levels in patients with cirrhosis.

Acquired factor VIII inhibitor in a non-haemophilic patient: successful treatment with plasma exchange associated with factor VIII concentrate and immunosuppressors.

We report the successful treatment of a 55-year-old man with an acquired factor VIII inhibitor, the appearance of which followed surgery for a carcinoma of the biliary tract. The patient, who had recurrent life-threatening bleeding episodes, was treated with intensive plasmapheresis, factor VIII concentrates, azathioprine and methylprednisolone. Disappearance of the inhibitor was observed after the second series of plasma exchanges. Controls 2 and 3 months after treatment confirmed the complete absence of the inhibitor and normal levels of factor VIII. The crucial role of plasma exchange is considered and discussed.

Esterase activity of rat muscle.

The esterasic capacity of a series of skeletal muscles in response to three hemisuccinate ester drugs was investigated in rats and compared to that on alpha-naphthylacetate as a reference esterase substrate. Marked variations between different muscles and between given muscles of animals of different sex were observed, indicative of a complex heterogeneity in muscular expression of esterase activity.