An enhanced fibrinolysis prevents the development of multiple organ failure in disseminated intravascular coagulation in spite of much activation of blood coagulation

Objectives: To investigate the relationship between fibrinolytic enhancemen t and the development of multiple organ failure (MOF) in disseminated intra vascular coagulation (DIC). To detect the useful prognostic index for outco me in DIG. Design: Case-control study. Setting: A department of internal medicine in a university hospital, a clin ical division for diagnosis and treatment, mainly of respiratory diseases, hematologic diseases, DIG, and other diseases requiring critical care medic ine. Patients: A total of 69 DIC patients, 31 with MOF. Interventions: None. Measurement and Main Results: The DIC patients with MOF had more elevated l evels of tissue plasminogen activator antigen (t-PA) and plasminogen activa tor inhibitor antigen (PAI), and more depressed levels of plasmin-alpha2 pl asmin inhibitor complex (PIC) and fibrin/fibrinogen degradation products th an those without MOF, although no significant difference in thrombin-anithr ombin complex (TAT) levels was observed. A fibrinolytic enhancement (shown by PIG) was parallel to an activation of blood coagulation (shown by TAT) i n DIC patients without MOF, although no such fibrinolytic enhancement was p rovoked even by much activation of blood coagulation in DIC patients with M OF. Whereas all the patients without MOF were restored from DIG, 14 of 31 p atients with MOF were unable to be restored from DIC and died. A significan t increase in plasma levels of t-PA and PAI under the condition of sustaine d hemostatic activation was observed in the patients who died. Conclusion: Enhanced fibrinolysis was considered to be the important defens e mechanism in preventing the development of MOF in DIG. The increases in p lasma levels of t-PA and PAI were poor prognostic markers in DIG. Further c areful study may be useful to clarify whether the fibrinolytic therapy is b eneficial in clinical DIC patients with MOF.