Fibrinolysis and Fibrinogenolysis in Disseminated Intravascular Coagulation

Hoyu Takahashi; Wataru Tatewaki; Ken Wada; Hiroe Niwano; Akira Shibata

doi:10.1055/s-0038-1645043

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 1990; 63(03): 340-344
DOI: 10.1055/s-0038-1645043

Original Article

Schattauer GmbH Stuttgart

Fibrinolysis and Fibrinogenolysis in Disseminated Intravascular Coagulation

Authors

Hoyu Takahashi

The First Department of Internal Medicine, Niigata University School of Medicine, Niigata, Japan
Wataru Tatewaki

The First Department of Internal Medicine, Niigata University School of Medicine, Niigata, Japan
Ken Wada

The First Department of Internal Medicine, Niigata University School of Medicine, Niigata, Japan
Hiroe Niwano

The First Department of Internal Medicine, Niigata University School of Medicine, Niigata, Japan
Akira Shibata

The First Department of Internal Medicine, Niigata University School of Medicine, Niigata, Japan

Abstract

PDF Download

Summary

In order to assess precisely the fibrinolytic state in disseminated intravascular coagulation (DIC), plasma levels of fibrinogenolysis products (FgDP), fibrinolysis products (FbDP) and fibrinogenolysis plus fibrinolysis products (TDP) were measured with newly developed enzyme-linked immunosorbent assays based on monoclonal antibodies in 72 patients with DIC at presentation. Not only FbDP and TDP but also FgDP were markedly elevated in patients with DIC. When analyzed according to the underlying disease categories, the relative proportion of FgDP to TDP was high in patients with acute promyelocytic leukemia and vascular diseases, and it was the lowest in patients with sepsis. Correlation analysis revealed that plasma levels of FgDP correlated negatively with alpha 2-antiplasmin and positively with plasmin-alpha 2-antiplasmin complex (PAP) and a ratio of PAP to thrombin-antithrombin III complex (TAT). These findings indicate that besides fibrinolysis, fibrinogenolysis is markedly accelerated in the majority of the patients with DIC.

PDF (357 kb)

References

References
1 Schwartz BS, Williams EC, Conlan MG, Mosher DF. Epsilon-aminocaproic acid in the treatment of patients with acute promyelo-cytic leukemia and acquired alpha-2-plasmin inhibitor deficiency. Ann Intern Med 1986; 105: 873-7
2 Avvisati G, Ten Cate JW, Sturk A, Lamping R, Petti MC, Mandelli F. Acquired alpha-2-antiplasmin deficiency in acute promyelocytic leukaemia. Br J Haematol 1988; 70: 43-8
3 Rylatt DB, Blake AS, Cottis LE, Massingham DA, Fletcher WA, Masci PP, Whitaker AN, Elms M, Buncc L, Webber AJ, Wyatt D, Bundcscn PG. An immunoassay for human D-dimer using monoclonal antibodies. Thro mb Res 1983; 31: 767-78
4 Whitaker AN, Elms MJ, Masci PP, Bundcscn PG, Rylatt DB, Webber AJ, Buncc IH. Measurement of cross linked fibrin derivatives in plasma: An immunoassay using monoclonal antibodies. J Clin Pathol 1984; 37: 882-7
5 Koopman J, Haverkate F, Koppert P, Nieuwenhuizen W, Brommer PE J, van der Werf CW G. New enzyme immunoassay of fibrin-fibrinogen degradation products in plasma using a monoclonal antibody. J Lab Clin Med 1987; 109: 75-84
6 Koppert PW, Kuipers W, Hoegee-de Nobel B, Brommer PE J, Koopman J, Nieuwenhuizen WA. quantitative enzyme immunoassay for primarv fibrinogcnolvsis products in plasma. Thromb Hacmostas 1987; 57: 25-8
7 Koppert PW, Hoegee-de Nobel E, Nieuwenhuizen W. A monoclonal antibody-based enzyme immunoassay for fibrin degradation products in plasma. Thromb Hacmostas 1988; 59: 310-5
8 Gaffney PJ, Creighton LJ, Callus M, Thorpe R. Monoclonal antibodies to crosslinked fibrin degradation products (XL-FDP). II. Evaluation in a variety of clinical conditions. Br J Haematol 1988; 68: 91-6
9 Nieuwenhuizen W. New strategies in the determination of fibrin and fibrin(ogen) derivatives by monoclonal antibodies. Blut 1988; 57: 285-91
10 Bennet JM, Catovsky D, Daniel MT, Flandrin G, Galton GD A, Gralnick HR, Sultan C. Proposals for the classification of the acute leukaemias. Br J Haematol 1976; 33: 451-8
11 Clauss A. Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogens. Acta Haematol 1957; 17: 237-46
12 Takahashi H, Takakuwa E, Yoshino N, Hanano M, Shibata A. Protein C levels in disseminated intravascular coagulation and thrombotic thrombocytopenic purpura: Its correlation with other coagulation parameters. Thromb Haemostas 1985; 54: 445-9
13 Pelzer H, Schwarz A, Heimburger N. Determination of human thrombin-antithrombin III complex in plasma with an enzyme-linked immunosorbent assay. Thromb Haemostas 1988; 59: 101-6
14 Takahashi H, Tatewaki W, Wada K, Yoshikawa A, Shibata A. Thrombin and plasmin generation in patients with liver disease. Am J Hematol 1989; 32: 30-5
15 Mimuro J, Koike Y, Sumi Y, Aoki N. Monoclonal antibodies to discrete regions in ±²-plasmin inhibitor. Blood 1987; 69: 446-53
16 Koppert PW, Koopman J, Haverkate F, Nieuwenhuizen W. Production and characterization of a monoclonal antibody reactive with a specific neoantigenic determinant (comprising Bβ 54–118) in degradation products of fibrin and of fibrinogen. Blood 1986; 68: 437-41
17 Koppert PW, Huijsmans GC M, Nieuwenhuizen W. A monoclonal antibody, specific for human fibrinogen, fibiinopeplide A-containing fragments and not reacting with free fibrinopcptidc A. Blood 1985; 66: 503-7
18 Takahashi H, Takizawa S, Tatewaki W, Nagai K, Wada K, Hanano M, Shibata A. Nafamostat mesilate (FUT 175) in the treatment of patients with disseminated intravascular coagulation. Thromb Haemostas 1989; 62: 372
19 Yushikawa T, Murakami M, Furukawa Y, Kato H, Takemura S, Kondo M. Effects of FUT-175, a new synthetic protease inhibitor on endotoxin-induced disseminated intravascular coagulation in rats. Haemostasis 1983; 13: 374-8
20 Nieuwenhuizen W. A double blind comparative study of six monoclonal antibody based plasma assays for fibrinogen derivatives. In: Fibrinogen 2. Biochemistry, Physiology and Clinical Relevance Lowe GD O, Douglas TJ, Forbes DC, Henschen A. (eds). Excerpta Medica. Amsterdam: 1987: 181-6
21 Sterrenberg L, Haak HL, Brommer PE J, Nieuwenhuizen W. Evidence of fibrinogen breakdown by leukocyte enzymes in a patient with acute promyelocytic leukemia. Haemostasis 1985; 15: 126-33
22 Plow EF. The contribution of leukocyte proteases to fibrinolysis. Blut 1986; 53: 1-9
23 Gralnick HR, Abrell E. Studies of the procoagulant and fibrinolytic activity of promyelocytes in acute promyelocytic leukaemia. Br J Haematol 1973; 24: 89-99
24 Wada H, Nagano T, Tomeoku M, Kuto M, Karitani Y, Deguchi K, Shirakawa S. Coagulant and fibrinolytic activities in the leukemic cell lysates. Thromb Res 1982; 30: 315-22
25 Takahashi H, Hanano M, Takizawa S, Tatewaki W, Shibata A. Plasmin-α₂-plasmin inhibitor complex in plasma of patients with disseminated intravascular coagulation. Am J Hematol 1988; 28: 162-6
26 Avvisati G, Ten Cate JW, Buller HR, Mandelli F. Tranexamic acid for control of haemorrhage in acute promyelocytic leukaemia. Lancet 1989; 2: 122-4
27 Neidart JA, Roach RW. Successful treatment of skeletal hemangioma and Kassabach-Merritt syndrome with aminocaproic acid. Is fibrinolysis “defective”?. Am J Med 1982; 73: 434-8
28 Bell AJ, Chisholm M, Hickton M. Reversal of coagulopathy in Kasabach-Merritt syndrome with tranexamic acid. Scand J Haematol 1986; 37: 249-52
29 Poon M-C, Kloiber R, Birdsell DC. Epsilon-aminocaproic acid m the reversal of consumptive coagulopathy wilh platelet sequestration in a vascular malformation of Klippel-Trenannary syndrome. Am J Med 1989; 87: 211-3
30 Colucci M, Paramo JA, Collen D. Generation in plasma of a fast-acting inliibitoi of plasminogen activator in response to endotoxin stimulation. J Clin Invent 1985; 75: 818-24
31 Paramo JA, Fernandez Lhaz FJ, Rocha E. Plasminogen activator inhibitor activity in bacterial infection. Thromb Haemostas 1988; 59: 451-4