Ascites-induced LeVeen Shunt Coagulopathy

Abstract

Of 11 patients undergoing peritoneovenous (LeVeen) shunt placement for intractable ascites, 10 had disseminated intravascular coagulation (DIC) following the shunt procedure. Intraoperative ascitic fluid specimens revealed fibrin split products (FSP) in high titer (1:100-1:1600) in all patients. Endotoxin was found in 6 of 11 ascitic fluid samples but in no plasma samples. Activated clotting factors, clot inhibitors, excess protein and fibrinolytic activity were not found in ascitic fluid. Clotting factor levels were much lower than in plasma. Bleeding occurred after operation in 2 patients; this appeared to be related to the severity of liver dysfunction as demonstrated by elevations of bilirubin, serum glutamic oxalacetic transaminase, serum glutamic pyruvic transaminase and preoperative DIC. The LeVeen shunt coagulopathy is DIC, and may be related to exposure of the systemic circulation of FSP-rich ascitic fluid that may activate the coagulation mechanism. Bleeding complications apparently are not related to the severity of the post-shunt coagulopathy but are related to the severity of liver dysfunction and presence of preoperative DIC (probably caused by the liver disease).