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Mixed Fibrinolytic Phenotypes in Decompensated Cirrhosis and Acute-on-Chronic Liver Failure with Hypofibrinolysis in Those With Complications and Poor Survival

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Mixed Fibrinolytic Phenotypes in Decompensated Cirrhosis and Acute-on-Chronic Liver Failure with Hypofibrinolysis in Those With Complications and Poor Survival. / Blasi, Annabel; Patel, Vishal C.; Adelmeijer, Jelle; Azarian, Sarah; Tejero, Maria Hernandez; Calvo, Andrea; Fernandez, Javier; Bernal, William; Lisman, Ton.

In: Hepatology, 24.10.2019.

Research output: Contribution to journalArticle

Harvard

Blasi, A, Patel, VC, Adelmeijer, J, Azarian, S, Tejero, MH, Calvo, A, Fernandez, J, Bernal, W & Lisman, T 2019, 'Mixed Fibrinolytic Phenotypes in Decompensated Cirrhosis and Acute-on-Chronic Liver Failure with Hypofibrinolysis in Those With Complications and Poor Survival', Hepatology. https://doi.org/10.1002/hep.30915

APA

Blasi, A., Patel, V. C., Adelmeijer, J., Azarian, S., Tejero, M. H., Calvo, A., ... Lisman, T. (2019). Mixed Fibrinolytic Phenotypes in Decompensated Cirrhosis and Acute-on-Chronic Liver Failure with Hypofibrinolysis in Those With Complications and Poor Survival. Hepatology. https://doi.org/10.1002/hep.30915

Vancouver

Blasi A, Patel VC, Adelmeijer J, Azarian S, Tejero MH, Calvo A et al. Mixed Fibrinolytic Phenotypes in Decompensated Cirrhosis and Acute-on-Chronic Liver Failure with Hypofibrinolysis in Those With Complications and Poor Survival. Hepatology. 2019 Oct 24. https://doi.org/10.1002/hep.30915

Author

Blasi, Annabel ; Patel, Vishal C. ; Adelmeijer, Jelle ; Azarian, Sarah ; Tejero, Maria Hernandez ; Calvo, Andrea ; Fernandez, Javier ; Bernal, William ; Lisman, Ton. / Mixed Fibrinolytic Phenotypes in Decompensated Cirrhosis and Acute-on-Chronic Liver Failure with Hypofibrinolysis in Those With Complications and Poor Survival. In: Hepatology. 2019.

Bibtex Download

@article{2a2a8fc39dbd48c6aa3b9c957a3982ae,
title = "Mixed Fibrinolytic Phenotypes in Decompensated Cirrhosis and Acute-on-Chronic Liver Failure with Hypofibrinolysis in Those With Complications and Poor Survival",
abstract = "Background and AimsPatients with liver disease acquire complex changes in their hemostatic system, which results in a fragile rebalanced status. The status of the fibrinolytic system is controversial, as is the role of fibrinolytic dysfunction in bleeding and thrombosis in patients with cirrhosis. Here, we aimed to determine fibrinolytic status and its relationship with outcome in acutely ill patients with cirrhosis.Approach and ResultsWe assessed plasma fibrinolytic potential in a large cohort of patients with acutely decompensated cirrhosis (AD, n = 52) or acute‐on‐chronic liver failure (ACLF, n = 57). Compared with 40 healthy volunteers, median clot lysis times (CLTs) were shorter in patients with AD but comparable to controls in patients with ACLF. However, the variability in CLTs in patients was much larger than in healthy controls, and in both patient groups, a proportion of patients had clearly prolonged or shortened CLTs. The variability in CLTs in patients was not readily explained by variations in plasma levels of key fibrinolytic proteins. However, CLTs were clearly related to clinical characteristics, with longer CLTs in patients with sepsis and patients with any organ failure (as defined by the European Foundation for the Study of Chronic Liver Disease organ failure scores). CLTs were not different between patients that did or did not experience bleeding or a thrombotic event during follow‐up. Baseline CLTs were substantially longer in patients that died within 30 days of admission.ConclusionsOur study demonstrates a mixed fibrinolytic phenotype in acutely ill patients with cirrhosis with baseline hypofibrinolysis associated with sepsis, organ failure, and short‐term mortality. These associations may be explained by defective clearance of intraorgan microthrombi that have been proposed to drive organ failure.",
author = "Annabel Blasi and Patel, {Vishal C.} and Jelle Adelmeijer and Sarah Azarian and Tejero, {Maria Hernandez} and Andrea Calvo and Javier Fernandez and William Bernal and Ton Lisman",
year = "2019",
month = "10",
day = "24",
doi = "10.1002/hep.30915",
language = "English",
journal = "Hepatology",
issn = "0270-9139",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Mixed Fibrinolytic Phenotypes in Decompensated Cirrhosis and Acute-on-Chronic Liver Failure with Hypofibrinolysis in Those With Complications and Poor Survival

AU - Blasi, Annabel

AU - Patel, Vishal C.

AU - Adelmeijer, Jelle

AU - Azarian, Sarah

AU - Tejero, Maria Hernandez

AU - Calvo, Andrea

AU - Fernandez, Javier

AU - Bernal, William

AU - Lisman, Ton

PY - 2019/10/24

Y1 - 2019/10/24

N2 - Background and AimsPatients with liver disease acquire complex changes in their hemostatic system, which results in a fragile rebalanced status. The status of the fibrinolytic system is controversial, as is the role of fibrinolytic dysfunction in bleeding and thrombosis in patients with cirrhosis. Here, we aimed to determine fibrinolytic status and its relationship with outcome in acutely ill patients with cirrhosis.Approach and ResultsWe assessed plasma fibrinolytic potential in a large cohort of patients with acutely decompensated cirrhosis (AD, n = 52) or acute‐on‐chronic liver failure (ACLF, n = 57). Compared with 40 healthy volunteers, median clot lysis times (CLTs) were shorter in patients with AD but comparable to controls in patients with ACLF. However, the variability in CLTs in patients was much larger than in healthy controls, and in both patient groups, a proportion of patients had clearly prolonged or shortened CLTs. The variability in CLTs in patients was not readily explained by variations in plasma levels of key fibrinolytic proteins. However, CLTs were clearly related to clinical characteristics, with longer CLTs in patients with sepsis and patients with any organ failure (as defined by the European Foundation for the Study of Chronic Liver Disease organ failure scores). CLTs were not different between patients that did or did not experience bleeding or a thrombotic event during follow‐up. Baseline CLTs were substantially longer in patients that died within 30 days of admission.ConclusionsOur study demonstrates a mixed fibrinolytic phenotype in acutely ill patients with cirrhosis with baseline hypofibrinolysis associated with sepsis, organ failure, and short‐term mortality. These associations may be explained by defective clearance of intraorgan microthrombi that have been proposed to drive organ failure.

AB - Background and AimsPatients with liver disease acquire complex changes in their hemostatic system, which results in a fragile rebalanced status. The status of the fibrinolytic system is controversial, as is the role of fibrinolytic dysfunction in bleeding and thrombosis in patients with cirrhosis. Here, we aimed to determine fibrinolytic status and its relationship with outcome in acutely ill patients with cirrhosis.Approach and ResultsWe assessed plasma fibrinolytic potential in a large cohort of patients with acutely decompensated cirrhosis (AD, n = 52) or acute‐on‐chronic liver failure (ACLF, n = 57). Compared with 40 healthy volunteers, median clot lysis times (CLTs) were shorter in patients with AD but comparable to controls in patients with ACLF. However, the variability in CLTs in patients was much larger than in healthy controls, and in both patient groups, a proportion of patients had clearly prolonged or shortened CLTs. The variability in CLTs in patients was not readily explained by variations in plasma levels of key fibrinolytic proteins. However, CLTs were clearly related to clinical characteristics, with longer CLTs in patients with sepsis and patients with any organ failure (as defined by the European Foundation for the Study of Chronic Liver Disease organ failure scores). CLTs were not different between patients that did or did not experience bleeding or a thrombotic event during follow‐up. Baseline CLTs were substantially longer in patients that died within 30 days of admission.ConclusionsOur study demonstrates a mixed fibrinolytic phenotype in acutely ill patients with cirrhosis with baseline hypofibrinolysis associated with sepsis, organ failure, and short‐term mortality. These associations may be explained by defective clearance of intraorgan microthrombi that have been proposed to drive organ failure.

UR - http://www.scopus.com/inward/record.url?scp=85074563609&partnerID=8YFLogxK

U2 - 10.1002/hep.30915

DO - 10.1002/hep.30915

M3 - Article

JO - Hepatology

JF - Hepatology

SN - 0270-9139

ER -

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