Can the Screening Clotting Tests Predict the Complicated Hemostatic Changes in Patients with Cirrhosis of Liver

In order to evaluate the homeostatic changes in patients with cirrhosis of liver, a series of haemostatic tests and parameters including activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), bleeding time (BT), factor Ⅷ assay, antithrombin Ⅲ (ATⅢ) activity, fibrinogen, plasminogen, protamine sulfate test (PST), fibrin (ogen) degradation product (FDP), D-dimer, thrombin-antithrombin Ⅲ complex (TAT) (measured by modified antithrombin Ⅲ, ATM), tissue plasminogen activator (tPA), plasminogen activator inbibitor-1 (PAI), euglobulin lysis test (ELT)and venous occlusion test (VOT)were performed in 51 cases of cirrhosis of live and 33 healthy controls. Factor Ⅷ, ATM, PAI, tPA. D-dimer and FDP were higher, fibrinogen, plasminogen, platelet and AT Ⅲ were lower, ELT was shorter and APTT, PT, TT and BT were longer in the cirrhotics than in the controls. When the cirrhotic patients were divided into 3 subgroups by different time ranges of APTT, the greatest difference of the hemostatic parameters was noted rather than by different time ranges of PT, TT or BT. On the other hand. PT had significant correlation with most of the other hemostasis parameters. Thus, among the most frequently used screening tests, APTT and PT were the most capable of demonstrating the homeostatic change in liver cirrhosis. AT Ⅲ and plasminogen were the most representative parameters to demonstrate the changes of the coagulation and the fibrinolysis parameters, respectively. We thus suggested that AT Ⅲ and plasminogen be performed in addition to the conventional screening tests to get more referential results. The increased fibrinolysis in liver cirrhosis might be primary, since TAT was not found to correlate well with fibrinogen. D-dimer, FDP, plasminogen, PAI, ELT or tPA in the present study. The VOT-induced fibrinolytic change was not significantly different between the cirrhotics and the controls, though increases of tPA and PAI and shortening of ELT were found in the cirrhotics. Thus, the fibrinolytic activity after stress was not impaired in patients with liver cirrhosis.