Hyper fibrinolysis in Liver Disease

The association between liver disease and accelerated fibrinolysis was described more than 80 years ago when the rapid reliquidification of incubated, clotted blood from cirrhotic patients was noted. In the current literature the occurrence of hyperfibrinolysis in patients who have cirrhosis has been suggested but is still debated. The reasons for this uncertainty probably lie in the lack of appropriate laboratory tests for the evaluation of hyperfibrinolysis. Thus, the assay of individual components rather than evaluation of the overall fibrinolytic activity has been investigated. Nonetheless, there is a relative consensus that hyperfibrinolysis may complicate the clinical course of patients who have cirrhosis or liver failure. In a previous study the incidence of hyperfibrinolysis, diagnosed by abnormal euglobulin lysis time, was 36%, comparable to most, but not all, previous reports in patients who underwent liver transplantation. Hyperfibrinolysis correlated positively with the severity of underlying liver disease (the Child-Pugh classification), and low-grade systemic fibrinolysis was found in 30% to 46% of patients who had end-stage liver disease. Therefore the debate regarding hyperfibrinolysis in liver disease focused essentially on the mechanism of hyperfibrinolysis and its role, if any, in the bleeding disorders complicating the clinical course of liver cirrhosis.