Assessment of Platelet Aggregation, and Fibrinolytic Activity in Egyptian Patients with Decompensated Liver Cirrhosis

Background: Advanced liver disease is commonly associated with complex haemostatic defects that include impaired synthesis of clotting factors and coagulation inhibitors in association with thrombocytopenia and platelets defects.

Aim of the Study: It was designed to determine whether a significant increase in circulating D-dimer levels and deterioration of platelet aggregation test may be observed in patients with liver cirrhosis complicated by ascites and bleeding tendency.

Patients and Methods: A total of 90 patients were studied and were classified into three groups. Group I included 30 patients with compensated liver disease, group II included 30 patients with decompensated liver disease without ascites and group III included 30 patients with decompensated liver cirrhosis with ascites. 30 normal healthy blood donors were considered as control group (IV). As well, the patients were classified into Child–Pugh class A to C. All participants were clinically evaluated, had routine laboratory investigations and assessment of platelets aggregation tests and plasma D-dimer was determined in all samples.

Results: Decreased platelet aggregation tests against various agonists such as adenosine diphosphate (ADP), epinephrine, ristocitin and collagen and elevated plasma D-dimer level showed high significant difference among the three studied groups being worse in group III (P 0.001). According to sub classification of patients to Child Pugh score decreased platelet aggregation tests and elevated plasma D-dimer revealed high significant difference between the three classes being worse in class C. (P>0.001).

Conclusion: Liver cirrhosis is implicated in alterations of platelet aggregation tests with platelet hypo-aggregability being more evident during relatively later disease stages compared with the earlier ones.