EVALUATION OF COAGULATION AND FIBRINOLYTI CS PARAMETERS IN THE THERAPEUTIC MANAGEMENT OF DISSEMINATED INTRAVASCULAR COAGULATION WITH SEPSISBY LOW-MOLECULAR-WEIGHT HEPARIN

Two groups of 15 patients each with disseminated intravascular coagula tion in association with septic disease were treated with low-molecula r-weight heparin (Imw-heparin) in different dosages (group I: 1,5-5 IE /kg body weight (BW) per hour; group II:8-15 IE/kg BW). We studied the levels of D-dimer, thrombin-antithrombin III complex (TBT), prothromb in fragments 1 and 2 (PTF), and global tests of coagulation like proth rombin time (PT), activated partial thromboplastin time (PTT), thrombi n time (TT) and platelet count, plasminogen activation (PA) and fibrin ogen concentration to estimate the success of heparin therapy in the t wo groups. TT and fibrinogen concentration were not suitable to follow the course of the coagulation disorder. PT, PTT, platelet count progr essively PA, D-dimer, TAT, and PTF normalised progressively after hepa rinisation. However,only the last three parameters were sensitive enou gh to show different effects of variable dosages of Imw-heparin. D-dim er, TAT, and PTF levels declined in proportion with heparin concentrat ions, and thus appear to be the most useful parameters for monitoring the therapeutic effect of heparin in septic coagulopathies.