Low levels of Thrombin Activatable Fibrinolysis Inhibitor (TAFI) in chronic liver disease

SummaryThrombin Activatable Fibrinolysis Inhibitor (TAFI) is a 60 κD glycoprotein present in plasma that regulates fibrinolysis by limiting the amount of fibrin available for fibrinolysis by tissue plasminogen activator (t-PA). Chronic liver disease is well-known to be associated with a low-grade fibrinolytic syndrome that under the appropriate stimulus proceeds to an overt disseminated intravascular coagulopathy (DIC) with demonstrable bleeding. In the present study, TAFI activity was measured in the plasma of 74 patients with advanced liver disease, and the levels of TAFI were related to those of other important coagulation and fibrinolytic factors. TAFI levels were very low and essentially undetectable in the plasma of patients with advanced hepatocellular liver disease. No relationship with the degradation products of fibrin was evident.

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Low levels of Thrombin Activatable Fibrinolysis Inhibitor (TAFI) in chronic liver disease

Gastroenterology ◽

10.1016/s0016-5085(08)81870-7 ◽

2001 ◽

Vol 120 (5) ◽

pp. A376

Author(s):

David H. Van Thiel ◽

Magdalena M. George ◽

Jon Amiral

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Chronic Liver ◽

Thrombin Activatable Fibrinolysis Inhibitor ◽

Fibrinolysis Inhibitor ◽

Low Levels

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Heparin Response and Clearance in Acute and Chronic Liver Disease

Thrombosis and Haemostasis ◽

10.1055/s-0038-1660076 ◽

1985 ◽

Vol 54 (03) ◽

pp. 591-594 ◽

Cited By ~ 12

Author(s):

H Sette ◽

R D Hughes ◽

P G Langley ◽

A E S Gimson ◽

R Williams

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Peak Level ◽

Chronic Liver ◽

Clotting System ◽

Activated Clotting Time ◽

At Iii ◽

Increased Sensitivity ◽

Low Levels ◽

Normal Controls

SummaryPatients with liver disease are at risk of bleeding due to abnormalities of the clotting system although they must be anticoagulated if they require haemodialysis or haemoperfusion. The anticoagulant of choice is heparin.In this study we have investigated heparin kinetics in patients with fulminant hepatic failure (FHF) after a single intravenous dose of heparin (2,500 units) and found there was an increased clearance of heparin whether measured by its anti-Xa effect (t1/2 = 27.8 ± 2.9 min compared to t1/2 = 50.2 ± 2.7 min in normal controls p <0.001) or by the whole blood activated clotting time (t1/2 = 23.7 ± 2.2 min compared to t1/2 = 37.0 ± 2.0 min p <0.001). There was a decreased peak level of heparin measured by anti-Xa effect (peak level in FHF = 0.48 ± 0.05 u/ml and in controls = 0.69 ± 0.04 u/ml, p <0.02), but an increased sensitivity to heparin (sensitivity in FHF = 0.072 ± 0.011 sec/unit, in controls 0.033 ± 0.003 sec/unit, p <0.001). Patients with FHF had very low levels of antithrombin III (AT III), but there was no correlation between this and any parameters of heparin effect or clearance. In a group of patients with chronic liver disease heparin kinetics did not differ from controls despite low levels of AT III.The changes in heparin kinetics in FHF are likely to be complex with the balance between the proteins that act as cofactors, (e.g. AT III) and the proteins that have heparin neutralising activity, controlling the response of added heparin.

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TRACE ELEMENTS IN PLASMA AND NUTRITIONAL ASSESSMENT IN PATIENTS WITH COMPENSATED CIRRHOSIS ON A LIVER TRANSPLANT LIST

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032016000200006 ◽

2016 ◽

Vol 53 (2) ◽

pp. 84-88 ◽

Cited By ~ 4

Author(s):

Thays Santana GUERRA ◽

Nelci Fenalt HOEHR ◽

Ilka de Fátima Santana Ferreira BOIN ◽

Raquel Silveira Bello STUCCHI

Keyword(s):

Trace Elements ◽

Liver Disease ◽

Nutritional Status ◽

Liver Transplant ◽

Trace Element ◽

Chronic Liver Disease ◽

Disease Severity ◽

Nutritional Assessment ◽

Chronic Liver ◽

Low Levels

ABSTRACT Background - In chronic liver disease, trace element levels in plasma are usually low. However, the specific cause and functional implications of this abnormality are yet not well understood. These element levels may decrease as a result of abnormal liver function in patients with cirrhosis and/or malnutrition. Objective - To evaluate the nutritional status and the profile of trace elements in plasma of patients with cirrhosis on a liver transplant list and to correlate them with disease severity. Methods - This cross-sectional study evaluated 31 male patients diagnosed with compensated liver cirrhosis on a waiting list for liver transplant. Nutritional status was objectively evaluated through anthropometry using Mendenhall score and Blackburn classification, subjectively through the Detsky questionnaire and severity of the disease by MELD and CTP score. Trace elements (Zn, Se, Cu, Ca, Fe, Mg and Mn) in plasma were analyzed by inductively coupled plasma mass spectrometry (ICP-MS). Statistical analysis was performed using Mann-Whitney test. Results - According to the nutritional assessment 19 (61.3%) were malnourished and 12 (38.7%) were overweight. Regarding disease severity 12 (39%) were classified as Child A, 17 (55%), Child B and 2 (6%) Child C, with 46.9% of patients with MELD score >17. The trace element analysis indicated that 31 (100%) had Mn levels above the reference range, 23 (74.2%) low levels of Cu, 29 (93.5%) with deficiency of Se, and 31 (100%) low levels of Ca and Mg. Disease severity did not show statistical difference between the studied trace elements, in contrast to the nutritional status, in which the malnourished group showed higher levels of Mn (P=0.01) and Fe (P=0.01) and low levels of Zn (P=0.03) when compared to the overweight group. Conclusion - The results showed that the trace elements in plasma are altered in chronic liver disease; without significant correlation to disease severity, but correlated to nutritional status. Malnutrition is present in the patients studied, nonetheless a new scenario with an increase in the prevalence of overweight was verified regardless of the degree of hepatic decompensation.

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