USE OF TPA-INDUCED CLOT LYSIS TIME (TCLOT) TO DIAGNOSE ABNORMAL CLOT STRUCTURE AND FIBRINOLYSIS IN A PATIENT WITH SPONTANEOUS BLEEDING INTOHIS LEG

Diagnosis and treatment of patients with bleeding due to enhanced fibr inolysis is hampered by the absence of a rapid screen of fibrinolytic potential. The authors have developed a simple assay to assess clot st ructure and fibrinolysis in patient samples exposed to tissue plasmino gen activator (TPA). They present the case of a forty-one-year-old man who presented with spontaneous bleeding despite normal results from c oagulation screening tests, platelet count, platelet aggregation studi es, platelet force development, and bleeding time. Evaluation of the p atient's clot structure revealed a very weak, low-modulus, clot that r apidly dissolved in the presence of TPA. Identification of the abnorma lity allowed treatment with epsilon-aminocaproic acid with prompt reso lution of bleeding.