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Thrombin Vs. Plasmin generation in disseminated lntravascular coagulation associated with various underlying disorders
Author(s) -
Takahashi Hoyu,
Tatewaki Wataru,
Wada Ken,
Hanano Masaharu,
Shibata Akira
Publication year - 1990
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.2830330204
Subject(s) - fibrinolysis , fibrinogen , disseminated intravascular coagulation , medicine , coagulation , plasmin , acute promyelocytic leukemia , coagulopathy , antithrombin , thrombin , gastroenterology , immunology , platelet , chemistry , heparin , biochemistry , retinoic acid , gene , enzyme
In order to assess the thrombin and plasmin generation in vivo in disseminated intravascular coagulation (DIC), plasma levels of thrombin‐antithrombin III (ATIII) complex (TAT) and plasmin‐alpha 2‐antiplasmin (a2AP) complex (PAP) were measured together with standard coagulation and fibrinolytic parameters in 80 patients with DIC. Both TAT and PAP were markedly elevated in patients with DIC. When plotted by the underlying disease categories, differences in the magnitude of the elevations of these complexes were recognized among groups. Patients with acute promyelocytic leukemia (APL) had the highest PAP, the lowest TAT/PAP ratio, low a2AP, and low fibrinogen, indicating that the most excessive fibrinolysis can occur in APL. Similar profiles, although less marked, were observed in patients with other leukemias and vascular diseases. Patients with sepsis showed the highest TAT/PAP ratio and the lowest PAP with no decrease in a2AP or fibrinogen, demonstrating a relatively impaired fibrinolysis. Patients with cancer had a relatively high TAT and high TAT/PAP ratio. In addition, both TAT and PAP were markedly elevated in patients with shock. From these, it was suggested that, although laboratory manifestations in DIC are extremely variable from patient to patient, underlying disorders are, at least in part, responsible for the observed variations. Recognition of this variable activation of coagulation and fibrinolysis would be helpful for the proper management of patients with DIC.