Fibrinolysis After Multiple Trauma In Man. Clinical And Methodological Aspects
Fifteen patients with at least two bone fractures and damages of soft tissues, mainly after traffic accidents, were investigated for changes in the fibrinolytic system. Seventeen healthy students were controls. The patients were conventionally treated in an intensive care unit. Blood samples, in all 140, were taken on the day of admission and then daily for about one week. The blood was analysed for plasminogen with electroimmunoassay and with chromogenic substrate after streptokinase activation, for α 2-antiplasmin with electroimmunoassay and two types of activity measurements (chromogenic substrate), for α 2-antiplasmin - plasmin complexes with RIA technique, and for α 2-macroglobulin with electroimmunoassay and activity measurements. In addition fibrinogen, fibrinogen-fibrin degradation products and fibrinolytic activity on fibrin plates were estimated.Plasminogen was somewhat low the first days after trauma lowest 69 % ± 22 % (M ± SD), day 3]. It then slowly increased towards the end of the investigation (highest 123% ± 21%). The last days of investigation the immunological method also gave higher values than the activity method, α 2 Antiplasmin was low directly after the trauma (lowest 67% ± 18%, day 1 ) and increased gradually (highest 115% ± 19%, day 6 ). The first days after trauma immunological method gave higher values than the activity methods, α 2 Antiplasmin - plasmin complexes varied, but showed occasionally high values in particular the first day. α 2 -Macroglobulin decreased only slightly on day 5-6, when it also showed a difference between the immunological and activity methods.It is concluded that the fibrinolytic system is activated immediately after a trauma. Later there is an increase of plasminogen, α 2 antiplasmin and fibrinogen, probably due to an acute phase reaction. Some reasons for the methodological discrepancies are discussed. Serial analysis of α 2-antiplasmin activity seems to be a relevant method for evaluation of fibrinolysis in a complex clinical situation.