Platelet aggregation and coagulation and fibrinolysis parameters in both portal and systemic circulations in patients with cirrhosis and hepatocellular carcinoma

A tendency to bleed and local vasodilation in the portal circulation are exacerbatory clinical factors in patients with liver cirrhosis. Esophageal variceal bleeding, in particular, is a frequent complication in these patients. Cirrhotic patients have been reported to show impairment of platelet aggregation and an activated fibrinolytic state, possibly with consequential lengthening of the bleeding time. Our previous study has demonstrated enhanced generation of PGI,, a vasodilating and anti-platelet aggregating hormone, ill the portal circulation of cirrhotic patients. In the present study, we compared the platelet aggregation and coagulation and fibrinolytic profiles in portal circulation with those in systemic circulation in twenty cirrhotic patients complicated with hepatocellular carcinoma. A portal blood sample was collected through a fine needle inserted percutaneously and guided ultrasonographically to the intrahepatic portal vein. Simultaneously, venous blood was drawn from a forearm vein as the systemic blood sample. Coagulation and fibrinolytic profiles were assessed by examining the extrinsic fibrinolytic system (tissue plasminogen activator (tPA), t-PA-plasminogen activator inhibitor complex), fibrinogen degeneration product, fibrinogen euglobulin lysis time, platelet count, and platelet aggregation elicited by ADP and collagen. Although fibrinolytic factors were activated in patients in the present study, there were no significant differences between the portal and systemic blood samples in all the coagulation and fibrinolytic parameters examined except for platelet aggregation. The curve of platelet aggregation response to collagen (1, 2, 10 mug/ml), but nor that to ADP, shifted significantly more to the right in the portal blood compared to the systemic blood (P < 0.05). This result suggested that the difference in prostaglandin generation reported previously, may cause the dissociation between collagen and ADP elicitation of platelet response in portal blood while there is no effect on other parameters in the coagulation and fibrinolytic profiles. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.