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Does decreased fibrinolysis have a role to play in the development of non-neoplastic portal vein thrombosis in patients with hepatic cirrhosis?

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Abstract

Hepatic cirrhosis is characterized by complex abnormalities of the fibrinolytic system. Little is known about the possible association between these alterations and thrombosis. The aim of this study was to evaluate the fibrinolytic profile in cirrhotic individuals with and without portal vein thrombosis (PVT). We measured thrombin activatable fibrinolysis inhibitor (TAFI), total amount of activated TAFI (TAFIa/ai), plasminogen activator inhibitor (PAI-1), plasminogen and fibrinogen plasma levels in 66 cirrhotic patients (33 with and 33 without PVT) and in 66 healthy volunteers. TAFI plasma levels (median [range]) were significantly lower in cirrhotic individuals (5.6 μg/ml [1.7–11.7]) than in controls (10.1 μg/ml [6.6–14.2], p < 0.0001), while TAFIa/ai levels were significantly higher in cases (18.3 ng/ml [0.3–35.4]) than in controls (15.9 ng/ml [7.4–41], p = 0.02). Cirrhotic patients with PVT had higher TAFI (6.6 μg/ml [2.9–10.1]), TAFIa/ai (19.2 ng/ml [11.6–35.4]) and PAI-1 (33.1 ng/ml [27.6–56.3]) plasma levels than those without PVT (3.9 μg/ml [1.7–11.7], p = 0.001; 15.6 ng/ml [10.3–33.9], p = 0.037; 15.9 ng/ml [2.5–29.1], p = 0.004. The fibrinolytic profile in cirrhotic individuals with PVT is characterized by higher levels of TAFI, TAFIa/ai and PAI-1 than in those without PVT. These alterations identify a hypofibrinolytic condition that may increase the risk of developing a thrombotic event.

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Conflict of interest

None except Barry Woodhams, ex Scientific Director at DiagnosticaStago, who now works as a consultant (HaemaCon Ltd, Bromley, UK).

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Authors and Affiliations

  1. Department of Cardiologic, Thoracic, and Vascular Sciences, 2nd Chair of Internal Medicine, University of Padua Medical School, Via Giustiniani 2, 35100, Padua, Italy

    Valeria Rossetto, Luca Spiezia, Sabrina Gavasso & Paolo Simioni

  2. Gastroenterology, Department of Surgical and Gastroenterological Sciences, University Hospital of Padua, Padua, Italy

    Marco Senzolo & Krissia Isabel Rodriguez-Castro

  3. R&D, DiagnosticaStago, Gennevilliers, France

    Barry Woodhams

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  1. Valeria Rossetto
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  2. Luca Spiezia
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Correspondence to Luca Spiezia.

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Rossetto, V., Spiezia, L., Senzolo, M. et al. Does decreased fibrinolysis have a role to play in the development of non-neoplastic portal vein thrombosis in patients with hepatic cirrhosis?. Intern Emerg Med 9, 397–403 (2014). https://doi.org/10.1007/s11739-013-0929-7

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