Critically ill patients have been described to have blood coagulation abnormalities that predispose to bleeding and thrombosis.We have studied plasminogen activators (fibrin plate, enzyme-linked Immunosorbent assay using polyclonalantibodies for t-PA), X-oligomers fibrin fragments (using monoclonal antibodies in an enzyme-linked immunosorbent assay), octant i pi asmin, antithrombtai III and fibronectin (Laurel1 innaunoeleetrophoretic technique), fibrinogen (thrombin timeassay), plateLets count, kaolln-cephalin clotting time and prothrombin time on admission to the intensive care unit and sequentially after 24 and 48 hours in 39 adult patients: Adult respiratory distress syndrome (ARDS) (n:6), Trauma (n:12), Sepsis (n:8), and Miscellanea (n:13).A decrease in tissue plasminogen activator (ng/ml)(p<0.001, p<0.05, p<0.01, p<0.05, respectively in the four groups), associated to an increase in the earliest form of cross-linked fibrin degradation products, X-Oligomers concentration (ng/ml) (p<0.01), indicatethat fibrindeposition and fibrinolytic exhaustion is a widespread situation in the ICU patients. Fibronectin was significantly reduced (p<0.001) in ARDS and Sepsis patients, low fibronectin levels were related to prognosis (p<0.01).These findings suggest.that critically ill patients, must be evaluated in respect to fibrinolysis and supported when necessary with prophylactic treatment.
Accumulations of von Willebrand factor within ECMO oxygenators: Potential indicator of coagulation abnormalities in critically ill patients?
