Analysis of coagulation disorders and assessment of rebalanced hemostasis with the use of traditional coagulation assays is challenging in cirrhotic patients. Therefore, alternative tests are under investigation for the evaluation of coagulopathy in this specific setting. Aim of this study was to analyze the modifications of clot structure and function in cirrhotic patients with different degrees of severity. Cirrhotic patients referred to our Unit were consecutively enrolled. Global test measurements, including clot and lysis assays, clot lysis time, and determination of other fibrinolytic parameters, were performed. Analyses of clot formation, morphology, and lysis were performed with a turbidimetric clotting and lysis assay (EuroCLOT). Lysis of a
tissue factor-induced clot by exogenous
tissue plasminogen activator was analyzed by studying the modifications of turbidity during clot formation and the following lysis. We evaluated coagulative and fibrinolytic parameters in both plasma and
ascites.
Urokinase plasminogen activator (uPA) and
gelatinase activity in
ascites were also measured. We analyzed data from 33 cirrhotic patients (11 in Child-Pugh class A; 22 in class B or C and with
ascites) and 21 healthy subjects (HS). In class B/C patients prolonged latency time, a decline in clotting absorbance, and decreased
fibrin formation were observed in comparison with class A and HS. Generated curves and
Thrombin-Activatable Fibrinolysis Inhibitor (TAFI) progressively declined from HS to class C patients, whereas levels of
plasminogen activator inhibitor-1 and
tissue plasminogen activator increased.
D-dimer levels were markedly increased in
ascites, together with significantly smaller levels of TAFI, αlfa2-antiplasmin, and
plasminogen. Caseinolytic activity was also present. Class C patients showed smaller amount of uPA and significantly lower levels of matrix
metallopeptidases (
MMP)2 in
ascites in comparison with Class B subjects. Clot formation and lysis are altered in
cirrhosis and fibrinolysis is activated in
ascites. Ascitic levels of uPA and MMP2 are reduced and inversely related to the severity of
liver disease.