Posttrauma coagulation and fibrinolysis.

Area of Science:

• Trauma research
• Coagulation and fibrinolysis
• Critical care medicine

Background:

• Trauma can trigger complex changes in the body's blood clotting and clot-dissolving systems.
• Disseminated intravascular coagulation (DIC) is a serious condition that can complicate trauma.
• The specific impact of head injury on these post-trauma systems requires further clarification.

Purpose of the Study:

• To investigate the effects of disseminated intravascular coagulation (DIC) on post-trauma coagulation and fibrinolysis.
• To assess the influence of head injury on these same post-trauma processes.
• To evaluate specific molecular markers of coagulation and fibrinolysis in trauma patients.

Main Methods:

• A case-control study involving 40 trauma victims (15 with DIC, 25 without).
• Measurement of six key coagulation and fibrinolytic molecular markers over 6 days post-trauma.
• Administration of anticoagulant treatment (gabexate mesilate) and assessment of its efficacy.

Main Results:

• Elevated levels of fibrinopeptide A, fibrinopeptide B beta 15-42, plasmin antiplasmin complex, and D-dimer were observed immediately after trauma and persisted for 6 days.
• Patients with DIC exhibited significantly higher marker values compared to non-DIC patients throughout the study period.
• Head-injured patients did not show increased coagulation or fibrinolytic activity; however, tissue plasminogen activator antigen concentration increased in DIC patients, suggesting potential inhibitor activity.

Conclusions:

• Head injury does not appear to increase post-trauma coagulation or fibrinolytic activity.
• DIC significantly enhances post-trauma coagulation and fibrinolytic activity, with evidence of plasminogen activator inhibitor activity.
• Elevated tissue plasminogen activator antigen concentration without activation may prognosticate DIC and its improvement, while fibrinopeptide A can assess anticoagulant treatment effectiveness.