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Assessment of Relative Contributions of Fibrinolysis and Fibrinogenolysis to the Abnormalities of Plasma Fibrinogen/Fibrin-Retated D and E Antigens and Their Ratio in Liver Cirrhosis

Many pathogenic mechanisms play a part in hemorrhage in chronic liver disease. This study was done to characterize the alterations of fibrinogen components and dysfibrinogenemia in patients with liver cirrhosis. Plasma from 31 patients with liver cirrhosis was analyzed to determine the fibrinogen/fibrin-related D and E antigens by latex photometric immunoassay; fibrinogen by the Clauss method; fibrinogen degradation product (FgDP), protein C antigen, and tissue plasminogen activator (tPA) by enzyme immunoassay; and antithrombin III by the colorimetric method, respectively. Reptilase, time and fibrin monomer (FM) tests were also done. Fibrinogen/fibrin-related D and E antigens were higher and their ratio (D/E) was lower in liver cirrhosis compared with normal subjects. Fibrinogen levels were inversely correlated with D (p = 0.0001) and E (p = 0.0001) antigenic levels in plasma. FgDP levels were not significantly correlated with D and E levels. However, semiquantitative D-dimer levels had significant association with D and E levels. Reptilase time was abnormally prolonged in all patients with high D and E levels, and FM tests were also positive in most patients with increased levels of D and E. Protein C antigen levels were inversely correlated with D (p = 0.0110) and E (p = 0.0112) concentrations but were well correlated with clottable fibrinogen concentrations (p = 0.0058). Hypercoagulability followed by pathologic activation of fibrinolysis, rather than synthesis of abnormal fibrinogen molecules, may contribute to hemorrhage. Not only true hypofibrinogenemia due to the decreased synthesis of intact fibrinogen but also elevated levels of these antigens may be clinically significant in the treatment of cirrhotic patients at risk of bleeding. Protein C may play an important regulatory role in fibrinolysis.