Association Between High D-dimer Plasma Levels and Ascites in Patients with Liver Cirrhosis - Zdravlje, medicina, lijecenje, zdravstveni portal

Association Between High D-dimer Plasma Levels and Ascites in Patients with Liver Cirrhosis

Association Between High D-dimer Plasma Levels and Ascites in Patients with Liver Cirrhosis
Aida Saray, Rusmir Mesihovic, Srdjan Gornjakovic, Nenad Vanis, Amila Mehmedovic, Kenan Nahodovic, Sanjin Glavas, Vedad Papovic
Med Arh. 2012; 66(6): 372-374

View PDF Fulltext


Objective: The aim of the study was to investigate plasma D-dimer concentration in patients with liver cirrhosis with and without ascites and to evaluate the impact of ascites depletion on circulating plasma D-dimer levels. Methods: Sixty patients with liver cirrhosis were recruited and categorized into two groups: cirrhotic patients without ascites in group 1 (n=30) and patients with liver cirrhosis and ascites in group 2 (n=30). D-dimer levels were measured on day of admission, in patients with ascites D-dimer concentration levels were repeated measured after ascites resolution cofirmed by ultrasonography. Results: Mean D-dimer levels showed significant increase in cirrhotic patients decompensated by ascites (626,0±231,08 μg/L) when compared with healthy controls (140,73±49,16 μg/L, p<0,001). There was also a statistically significant increase of mean D-dimer levels in patients with liver cirrhosis and no evidence of ascites (333,4±109,05 μg/L, p<0,001). In all patients after ascites resolution D-dimer levels showed significant reduction (437,66±130,47 μg/L, p<0,05). Values of D-dimer levels achieved after abdominal paracenthesis (n=21) where still higher than those in patients without ascites (480,14±122,85 μg/L, p=0,001). In cirrhotic patients treated with diuretic therapy (n=9) circulating D-dimer levels were not significantly different from those in cirrhotic patients without ascites (338,56±90,55 μg/L, p=0,96). Conclusion: The presence of ascites in patients with liver cirrhosis is associated with increased plasmatic fibrinolytic activity. Less aggressive ascites resolution therapy has an greater impact on reducing plasmatic fibrinolytic activity than achieved by abdominal paracenthesis.


1. Francis RB Jr, Feinstein DI.Clinical significance of accelerated fibrinolysis in liver disease.Haemostasis. 1984; 14(6): 460-465.

2. Amitrano L, Guardascione MA, Brancaccio V, Balzano A. Coagulation disorders in liver disease. Semin Liver Dis. 2002 ; 22(1): 83-96.

3. Patrassi GM, Sartori MT, Sgarabotto D, Sturniolo G, Boeri G, Girolami A. A DIC-like picture on plasma and ascitic fluid of cirrhotic patients. Res Exp Med (Berl). 1988; 188(5) :351-356.

4. Toschi V, Rocchini GM, Motta A, Fiorini GF, Cimminiello C,Violi F et al. The hyperfibrinolytic state of liver cirrhosis: possible pathogenetic role of ascites. Biomed Pharmacother. 1993; 47: 345-352.

5. Agarwal S, Joyner KA Jr, Swaim MW. Ascites fluid as a possible origin for hyperfibrinolysis in advanced liver disease. Am J Gastroenterol 2000. 95: 3218-3224.

6. Hu KQ, Yu AS, Tiyyagura L, Redeker AG, Reynolds TB. Hyperfibrinolytic activity in hospitalized cirrhotic patients in a referral liver unit. Am J Gastroenterol. 2001 ; 96(5): 1581-1586.

7. Car JM. Disseminated intravascular coagulation in cirrhosis.Hepatology. 1989; 10: 103-110

8. Violi F, Ferro D, Basili S, et al.Hyperfibrinolysis resulting from clotting activation in patients with different degree of cirrhosis.Hepatology. 1993; 17: 78-83

9. Steib A, Gengenwin N, Freys G, Boudjema K, Levy S, Otteni JC. Predictive factors of hyperfibrinolytic activity during liver transplantation in cirrhotic patients.Br J Anaesth. 1994; 73(5): 645-648.

10. Violi F, Alessandri C, Ferro D, Saliola M, Cordova C, Musca A, Balsano F. Interrelation between factor VII, prekallikrein, and hyperfibrinolysis in advanced cirrhosis.J Clin Pathol. 1989; 42(12): 1246-1249.

11. Violi F, Basili S, Ferro D, Quintarelli C, Alessandril C, Cordova C. Association between high values of D-dimer and tissue-plasminogen activator activity and first gastrointestinal bleeding in cirrhotic patients. CALC Group.Thromb Haemost. 1996; 76(2): 177-183.

12. Spadaro A, Tortorella V, Morace C, Fortiguerra A, Composto P, Bonfiglio C et al. High circulating D-dimers are associated with ascites and hepatocellular carcinoma in liver cirrhosis. World J Gastroenterol. 2008; 14(10): 1549-1552.

13. Piscaglia F, Donati G, Giannini R, Bolondi L. Liver cirrhosis, ascites, and hyperfibrinolysis. Am J Gastroenterol. 2001; 96: 3222.

Leave a reply

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>