TIME-COURSE OF CLOTTING AND FIBRINOLYTIC MARKERS IN ACUTE UPPER GASTROINTESTINAL-BLEEDING - RELATION TO DIAGNOSIS AND BLOOD-TRANSFUSION TREATMENT

One hundred consecutive patients with acute upper gastrointestinal ble eding were investigated. Blood coagulation and fibrinolytic activity w ere monitored by levels of plasma thrombin-antithrombin III (TAT) comp lex and plasmin-alpha(2)-antiplasmin (PAP) complex in samples obtained from patients at admission with haematemesis and/or melaena and in sa mples obtained from patients the first day after admission. Blood was transfused according to a restrictive policy. Median plasma TAT comple x was significantly elevated bath at admission and on the first day af ter admission compared with a reference group. plasma PAP complex leve ls were normal at admission but decreased on the first day after admis sion. This decrease was independent of blood transfusion. The results indicate hypercoagulability at admission among patients with upper gas trointestinal haemorrhage reinforced by the development of a hypofibri nolytic state during the first day after admission. Restricted blood t ransfusion was not associated with any detectable change in blood coag ulation or fibrinolysis in these patients.