{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T10:47:35Z","timestamp":1792838855364,"version":"4.5.0"},"reference-count":35,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2021,5,21]],"date-time":"2021-05-21T00:00:00Z","timestamp":1621555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Medical Scientific Fund of the Major of the City of Vienna","award":["15062"],"award-info":[{"award-number":["15062"]}]},{"name":"Austrian Science Fund (FWF) Special Research Program","award":["SFB-F54"],"award-info":[{"award-number":["SFB-F54"]}]},{"DOI":"10.13039\/100008594","name":"European Hematology Association","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100008594","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Development of ascites is the most common form of decompensation of cirrhosis. We aimed to investigate the coagulation system in ascitic fluid and plasma of patients with cirrhosis. We determined coagulation parameters and performed clotting and fibrinolysis experiments in ascitic fluid and plasma of thoroughly characterized patients with cirrhosis and ascites (n\u2009=\u200925) and in plasma of patients with cirrhosis but without ascites (n\u2009=\u200925), matched for severity of portal hypertension. We also investigated plasma D-dimer levels in an independent cohort of patients (n\u2009=\u2009317) with clinically significant portal hypertension (HVPG \u2265 10\u2009mmHg), grouped according to ascites severity. Ascitic fluid was procoagulant in a clotting assay. The procoagulant potential of ascitic fluid was abolished by depletion of extracellular vesicles from ascitic fluid by filtration or by addition of a tissue factor-neutralizing antibody. Compared with plasma, extracellular vesicle-associated tissue factor activity was high in ascitic fluid, while activities of other coagulation factors were low. The extracellular vesicle-depleted fraction of ascitic fluid induced fibrinolysis, which was prevented by aprotinin, indicating the presence of plasmin in ascitic fluid. Plasma peak thrombin generation and parameters reflecting fibrinolysis were independently associated with the presence of ascites. Finally, plasma D-dimer levels were independently linked to ascites severity in our second cohort comprising 317 patients. In conclusion, coagulation and fibrinolysis become activated in ascites of patients with cirrhosis. While tissue factor-exposing extracellular vesicles in ascitic fluid seem unable to pass the peritoneal membrane, fibrinolytic enzymes get activated in ascitic fluid and may re-enter the systemic circulation and induce systemic fibrinolysis.<\/jats:p>","DOI":"10.1055\/a-1515-9529","type":"journal-article","created":{"date-parts":[[2021,5,21]],"date-time":"2021-05-21T23:13:21Z","timestamp":1621638801000},"page":"353-362","source":"Crossref","is-referenced-by-count":18,"title":["Intraperitoneal Activation of Coagulation and Fibrinolysis in Patients with Cirrhosis and Ascites"],"prefix":"10.1055","volume":"122","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9613-8658","authenticated-orcid":false,"given":"Johannes","family":"Thaler","sequence":"additional","affiliation":[{"name":"Division of Haematology and Haemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ton","family":"Lisman","sequence":"additional","affiliation":[{"name":"Department of Surgery, Surgical Research Laboratory and Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Quehenberger","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Hell","sequence":"additional","affiliation":[{"name":"Division of Haematology and Haemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Schwabl","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Scheiner","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Bucsics","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rienk","family":"Nieuwland","sequence":"additional","affiliation":[{"name":"Laboratory of Experimental Clinical Chemistry, Vesicle Observation Centre, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cihan","family":"Ay","sequence":"additional","affiliation":[{"name":"Division of Haematology and Haemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Trauner","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Pabinger","sequence":"additional","affiliation":[{"name":"Division of Haematology and Haemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Reiberger","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2330-0017","authenticated-orcid":false,"given":"Mattias","family":"Mandorfer","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,7,4]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1038\/ajg.2016.498","article-title":"Changing concepts of cirrhotic coagulopathy","volume":"112","author":"A Tripodi","year":"2017","journal-title":"Am J Gastroenterol"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1002\/rth2.12028","article-title":"Pathogenesis, prevention, and management of bleeding and thrombosis in patients with liver diseases","volume":"1","author":"T Lisman","year":"2017","journal-title":"Res Pract Thromb Haemost"},{"issue":"09","key":"ref3","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1016\/j.cgh.2013.02.026","article-title":"Coagulation in liver disease: a guide for the 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