[Recommendations for initial diagnosis and therapy in acute blood coagulation disorders]

Acute disturbances of blood coagulation during operations and intensive therapy require quick and precise action in order to avoid life-threatening situations. This paper reports on a simple system for the diagnosis and therapy of acute disturbances of blood coagulation. In the initial phase of bleeding, determination of fibrin monomers, d-dimers, reptilase time, number of platelets and AT III enables diagnosis of disseminated intravascular coagulation (DIC), hyperfibrinolysis and consumption coagulopathy. Particular attention is paid to local hyperfibrinolysis, a relatively rare complication but of high diagnostic importance. After some remarks on the recommended clinical test parameters, the principles of the treatment of various coagulation disturbances are described. AT III is of special importance for the treatment of DIC, where as different opinions exist regarding the application of heparin. Aprotinin has long proved successful in the specific treatment of hyperfibrinolysis. Using clinical examples, the practicability of the recommended diagnostic and therapeutic measures is demonstrated.