STUDY OF THE BALANCE BETWEEN COAGULATION AND FIBRINOLYSIS IN DISSEMINATED INTRAVASCULAR COAGULATION USING MOLECULAR MARKERS

Plasma levels of thrombin-antithrombin III complex (TAT), plasmin-alph a(2)-plasmin inhibitor complex (PIC) and active plasminogen activator inhibitor (PAI) were assayed in 66 cases of disseminated intravascular coagulation (DIC). Significant elevation of both TAT and PIC was obse rved in all cases of DIC. Most elevated levels of TAT were seen in DIC with acute promyelocytic leukaemia (APL) and sepsis. The highest leve ls of PIC were seen in DIC with APL but were much lower in sepsis. A s ignificant elevation in active PAI was observed in DIC due to acute le ukaemia (apart from APL), chronic myeloid leukaemia and sepsis, but no t in APL, non-Hodgkin lymphoma and cancer. Active PAI was higher in pa tients with multiple organ failure (MOF) than in those without MOF whi le PIC was lower in patients with this complication. Thus, the balance of coagulation and fibrinolysis varied according to the underlying ca use of DIC; APL had more dominant activation of fibrinolysis, while se psis had greater activation of coagulation. It is suggested that the i nhibition of secondary fibrinolytic activation plays an important role in the progression of MOF by the disturbance of the microcirculation.