ENDOTOXEMIA HYPERFIBRINOLYSIS AND BLEEDING IN LIVER CIRRHOSIS

Abstract

Variceal bleeding is a life-threatening complication of liver cirrhosis. Bacterial infections are common complications in cirrhosis and it is estimated that about 40o/o of hospitalized cirrhotic pa6ents develop such infection (Caly and Strauss, 1993).

In particular, bacterial infections are very comn1only detected in cirrhotic patients with gastrointestinal bleeding and are associated with failure to control bleeding (Bernard et a/., 1995 ond Go1.ilis el of., 1998).

Bacterial infections, particularly endotoxemia have been shown to inactivate the coagulation system and generally to interfere with hemostasis in vitro or in animal models (Hewett and Roth, 1993 and Beat and Cerra, 1994).

In patients with decompensated cirrhosis, complex and

1nultifactorial coagulation abnormalities are often present (Marnmen, 1992) and endotoxemia have been associated with low grade disseminated intravascular coagulopathy (Violi et a/., 1995). Endotoxemia 111 patients with cirrhosis could be an important trigger of bleeding (Goulis et a/., 1999). They