Summary
Cirrhotic patients with decompensated state and high serum levels of fibrin(ogen)
degradation products are at high risk of bleeding. The aim of this study was to further
analyse the relationship between hyperfibrinolysis and bleeding in cirrhosis by measuring
plasma values of D-dimer and tissue plasminogen activator (t-PA) activity. One-hundred-twelve
cirrhotic patients with oesophageal varices and without previous upper-gastrointestinal
bleeding entered the study and were followed-up for 3 years. Patients were considered
to have hyperfibrinolysis if they concomitantly had high values of D-dimer and t-PA
activity. During the follow-up 34 (30%) patients bled. They had more severe liver
failure (p = 0.0001) and variceal size (p = 0.0031) and higher prevalence of ascites
(p = 0.0003), varices with red signs and hyperfibrinolysis (p = 0.0001) than patients
who did not bleed. Multivariate analysis disclosed hyperfibrinolysis as the only marker
predictive of bleeding (Hazard Ratio = 42.5, p <0.001). Our findings suggest that
screening for hyperfibrinolysis may be useful to identify cirrhotic patients at risk
of bleeding.
