Patients with cirrhosis have a disbalance between coagulation and fibrinolysis resulting in a prothrombotic phenotype.

IF 5.5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis Pub Date : 2025-03-06 DOI:10.1016/j.jtha.2025.02.034

Ruth Anne Laura Willems, Alberto Zanetto, Elena Campello, Ilaria de Simone, Cristiana Bulato, Joke Konings, Matthijs Kramer, Samia Tufaha, Francesco Paolo Russo, Marco Senzolo, Patrizia Burra, Hugo Ten Cate, Judith de Vos-Geelen, Mark Roest, Paolo Simioni, Bas de Laat, Dana Huskens

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引用次数: 0

Abstract

Background: Patients with cirrhosis develop multiple hemostatic alterations. Although fibrinolysis is also affected by liver disease, studies have produced conflicting results, highlighting the need for a reliable fibrinolysis assay. Assessing the kinetics of plasmin generation (PG) is a new method to study the fibrinolytic state of cirrhosis patients.

Objectives: This study aimed to compare fibrinolysis between patients with cirrhosis and healthy subjects.

Methods: This single-center cohort study included cirrhosis patients from the Padova University Hospital. Fibrinolysis and hemostasis were assessed with PG, thrombin generation (TG), and clot lysis time. To quantify malalignment between TG and PG, ratios were calculated.

Results: In total, 101 patients with cirrhosis (Child-Pugh A/B/C: 36/24/41) and 20 healthy subjects were included. Compared with healthy subjects, patients showed a significantly lower endogenous plasmin potential and plasmin peak. The PG capacity decreased with liver disease severity. The lag time to PG was prolonged in patients. No differences in endogenous thrombin potential and lag time were found when comparing TG profiles. Patients had a shorter clot lysis time. Increased TG/PG ratios for the endogenous plasmin potential and plasmin peak were found in patients compared with that in controls. TG/PG ratios increased with liver disease severity.

Conclusion: Patients with cirrhosis have a complex fibrinolytic profile, with a delayed and decreased capacity to generate plasmin and a more rapid clot lysis. A disbalance was found between coagulation and fibrinolysis, with a normal-to-increased TG capacity and a decreased PG capacity. These results support the theory that cirrhosis patients are in a prothrombotic state.

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肝硬化患者在凝血和纤溶之间存在不平衡，导致血栓形成前表型。

背景：肝硬化患者出现多种止血改变。虽然纤维蛋白溶解也受肝脏疾病的影响，但研究结果相互矛盾，强调需要可靠的纤维蛋白溶解测定。评价纤溶酶生成动力学（PG）是研究肝硬化患者纤溶状态的新方法。目的：本研究旨在比较肝硬化患者和健康人的纤溶情况。方法：这项单中心队列研究纳入了帕多瓦大学医院的肝硬化患者。通过PG、凝血酶生成（TG）和凝块溶解时间（CLT）评估纤维蛋白溶解和止血情况。为了量化TG和PG之间的偏差，计算了比值。结果：共纳入101例肝硬化患者（Child-Pugh A/B/C: 36/24/41）和20例健康受试者。与健康受试者相比，患者内源性纤溶酶电位（EPP）和纤溶酶峰明显降低。PG容量随肝病严重程度降低。患者到PG的滞后时间延长。在比较TG谱时，内源性凝血酶电位（ETP）和滞后时间没有差异。患者的CLT时间较短。与对照组相比，患者中EPP和纤溶酶峰值的TG/PG比值升高。TG/PG比值随肝病严重程度的增加而增加。结论：肝硬化患者具有复杂的纤维蛋白溶解特征，产生纤溶蛋白的能力延迟和降低，凝块溶解更快。在凝血和纤溶之间发现不平衡，TG容量正常到增加，PG容量下降。这些结果支持肝硬化患者处于血栓形成前状态的理论。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Thrombosis and Haemostasis 医学-外周血管病

CiteScore

24.30

自引率

3.80%

发文量

321

审稿时长

1 months

期刊介绍： The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.