Association of abnormal fibrin polymerisation with severe liver disease

SUMMARY The frequent occurrence of abnormal fibrin polymerisation in patients with liver disease has recently been reported. To investigate this further, fibrin polymerisation was studied in 68 patients with cirrhosis or chronic active liver disease. Thirty-three of these patients demonstrated impair-ment of this phase of blood coagulation. When other tests of liver function were compared in patients demonstrating this abnormality and those in whom fibrin polymerisation was normal, it was found that the former group demonstrated significantly reduced albumin concentrations (p < 0-0002), raised bilirubin and aspartate aminotransferase levels (p < 0 0006 and < 0 003 respectively), and greater prolongation of the one-stage prothrombin time (p < 0-001) with more marked reduc-tion in factor VII levels (p < 0 002) compared with the latter patients. It is concluded that defective fibrin polymerisation occurring in patients with liver disease indicates the presence of severely impaired hepatocellular function. This might account for the grave prognosis reported in cirrhotic patients with abnormal fibrin polymerisation who also suffer bleeding from gastro-oesophageal varices. Among the many abnormalities of blood coagulation in patients with liver disease, delayed conversion of fibrinogen to fibrin clot under the influence of thrombin is a common laboratory finding. Evidence has been presented to implicate a disturbance of fibrin polymerisation in these patients as a cause of the prolonged thrombin time (Von Felten et al.