High circulating D-dimers are associated with presence of ascites

The liver is the production site of most of the proteins which favour and inhibit the process of coagulation and fibrinolysis. Patients with liver cirrhosis may develop serious coagulopathy and a hyperfibrinolytic state, which contributes to the bleeding tendency. Plasma levels of fragment D-dimer (D-dimer) represent an accurate marker of fibrinolytic activity. The finding of a high plasma D-dimer concentration in patients with liver cirrhosis, decompensated with ascites, led Agarwal et al. to suggest the major role of ascites in the pathogenesis of the hyperfibrinolytic state associated with liver failure.

This study, published in the March 14, 2008, issue of the World Journal of Gastroenterology, shows that high circulating D-dimer levels are associated with the presence of ascites, and these decrease or return to normal following its resolution. The depletion of ascitic fluid might prevent bleeding complications, especially if invasive procedures become necessary. Interestingly enough, in the absence of ascites, high D-dimer levels are associated with the presence of hepatocellular carcinoma (HCC). HCC is a frequent complication of liver cirrhosis and its detection at an early stage is important. The finding of high plasma D-dimer levels in cirrhotic patients without ascites may represent a marker of HCC.

Reference: Spadaro A, Tortorella V, Morace C, Fortiguerra A, Composto P, Bonfiglio C, Alibrandi A, Luigiano C, Caro GD, Ajello A, Ferra¨´ O, Freni MA. High circulating D-dimers are associated with ascites and hepatocellular carcinoma in liver cirrhosis. World J Gastroenterol 2008; 14(10): 1549-1552
http://www.wjgnet.com/1007-9327/14/1549.asp

Correspondence to: Dr. Aldo Spadaro, Departments of Medicine and Pharmacology, Clinica Medica, Pad C ¨C University Hospital, Via Consolare Valeria, Messina 198125, Italy. aldo.spadaro@unime.it
Telephone: +39-90-2212333 Fax: +39-90-693917

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