To clarify an effect of ascitic fluid on the levels of plasma coagulation-fibrinolysis parameters in patients with liver cirrhosis, the levels of thrombin antithrombin III complex (TAT), α2plasmin inhibitor-plasmin complex (PIC), D-dimer, tissue plasminogen activator (t-PA), and plasminogen activator inhibitor 1 (PAI-1) were compared with ascitic fluid and plasma.
In ascitic fluid, the levels of TAT, PIC and D-dimer were significantly higher than those levels in plasma. Moreover, plasma levels of both D-dimer and TAT were significantly decreased when the ascitic fluid was disappeared by treatment. On the other hand, plasma levels of PIC, were relatively not related whether the ascites was present or not. These results may indicate that the consumption of coagulation and fibrinolysis factors in plasma was induced by activated coagulation system in ascitic fluid.
According to the levels of t-PA, there was no significant difference between in plasma and in ascitic fluid. However, PAT-1 could hardly be detected in ascitic fluid. Those findings indicated that marked comsumption of PAT-1 had been occurred in ascitic fluid due to the formation of t-PA and PAT-1 complex as an inhibitory mechanism for hyperfibrinolysis.
In conclusion, on the assessment of plasma coagulation and fibrinolytic parameters in decompensated liver cirrhosis, an effect of the ascites could not be ignored. Moreover, an evaluation of disseminated intravascular coagulation complicated in the patients with ascites, it thought to be necessary to refer to not only the levels of plasma D-dimer and TAT but also the levels of PIC.
