Differences in Activation of Coagulation and Fibrinolysis After Polytrauma with Respect to the Development of Adult Respiratory Distress Syndrome

  • W. Schramm
  • M. Spannagl


It is well-known that soluble fibrin is found in dissminated intravascular coagulation (DIC) and it has often been described in the microcirculation of polytrauma patients. This proves the role of thrombin in this disease. A lot of changes in hemostatic factors and end products can be explained by excessive production of thrombin leading to an increase in intermediate and end products (fibrinopeptide A, fibrin monomers, and protease inhibitor complexes), and to the consumption of clotting factors and inhibitors (fibrinogen and antithrombin III, AT III) [5, 13, 19, 22, 23]. For this reason thrombin inhibition has played an important role in therapy for many years, but until now no significant improvement using low-dose heparin therapy or substitution with AT III could be demonstrated in randomized and prospective studies.


Adult Respiratory Distress Syndrome False Positive Prediction Human Normal Plasma Soluble Fibrin True Positive Prediction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bachofen M, Weibel EF (1982) Structural alternations of lung parenchyma in the adult repiratory distress syndrome. Clin Chest Med 3:35–56PubMedGoogle Scholar
  2. 2.
    Bone RC, Francis PB, Pierce AK (1976) Intravascular coagulation associated with the adult respiratory distress syndrome. Am J Med 61:585–589PubMedCrossRefGoogle Scholar
  3. 3.
    Büsing CM, Bleyl U (1977) Plasminogen activatory activity of pulmonary vessels in shock. Thromb Res 11:285–295PubMedCrossRefGoogle Scholar
  4. 4.
    D’Angelo A, Kluft C, Verheijen JH, Rijken DC, Mozzi E, Mannucci PM (1985) Fibrinolytic shut-down after surgery: impairment of the balance between tissue-type plasminogen activator and its specific inhibitor. Eur J Clin Invest 15:308–312PubMedCrossRefGoogle Scholar
  5. 5.
    Duswald KH, Jochum M, Schramm W, Fritz H (1985) Released granulocytic elastase: an indicator of pathobiochemical alterations in septicemia after abdominal surgery. Surgery 9815:892–899Google Scholar
  6. 6.
    Eriksson E, Risberg B (1988) Tissue plasminogen activator and its inhibitor following major surgery in relation to ventilatory pattern. Acta Chir Scand 154:57–60PubMedGoogle Scholar
  7. 7.
    Holvoet P, Cleemput H, Collen D (1985) Assay of human tissue-type plasminogen activator (t-PA) with an enzyme-linked immunosorbent assay (ELISA) based on three murine monoclonal antibodies to t-PA. Thromb Haemost 54:684–687PubMedGoogle Scholar
  8. 8.
    Juhan-Vague I, Ailaud MF, De Cock F, Philip-Joet C, Arnaud C, Serradigmin A, Collen D (1985) The fast-acting inhibitor of tissue-type plasminogen activator is an acute phase reactant protein. In: Davidson JF, Donati MB, Cocceri S (eds) Progress in fibrolysis, vol VII. Churchill Livingstone, Edinburgh, ppl46–149Google Scholar
  9. 9.
    Kluft C, de Bart ACW, Bartheis M, Sturm J, Möller W (1988) Short term extreme increases in plasminogen activator inhibitor I (PAI 1) plasma of polytrauma patients. Fibrinolysis 2:223–226CrossRefGoogle Scholar
  10. 10.
    Kluft C, Verheijen JH, Jie AFH, Rijken DC, Preston FE, Sue-Ling HM, Jespersen J, Aasen AO (1985) The postoperative fibrinolytic shutdown: a rapidly reverting acute phase pattern for the fast-acting inhibitor of tissue-typed plasminogen activator after trauma. Scand J Clin Lab Invest 45:605–610PubMedCrossRefGoogle Scholar
  11. 11.
    McLoughlin GA, Grindlinger GA, Manny J, Valeri CR, Lipinski CR, Mannick JA, Hechtman Hb (1979) Intrapulmonary clotting and fibrinolysis during abdominal aortic aneurysm surgery. Ann Surg 190:623–630PubMedCrossRefGoogle Scholar
  12. 12.
    Nilsson K, Rosen S, Friberger P (1987) A new kit for the determination of tissue plasminogen activator and its inhibition in blood. Fibrinolysis 1:163–168CrossRefGoogle Scholar
  13. 13.
    Ordog GJ, Wasserberger J (1985) Coagulation abnormalities in traumatic shock. Ann Emerg Med 14:650–655PubMedCrossRefGoogle Scholar
  14. 14.
    Risberg B (1975) Fibrinolysis in the lung. Acta Chir Scand [Suppl] 458Google Scholar
  15. 15.
    Schleef RR, Loskutoff DJ (1988) Fibrinolytic system of vascular endothelial cells: role of plasminogen activator inhibitors. Haemostasis 18:328–341PubMedGoogle Scholar
  16. 16.
    Schramm W (1984) Cl-esterase inhibitor. In: Bergmayer HU (ed) Methods of enzymatic analysis, vol 5. VCH, Weinheim, pp 461–466Google Scholar
  17. 17.
    Sitrin RG, Brubaker PG, Fantone J (1987) Tissue fibrin deposition during acute lung injury in rabbits and its relationship to local expression of procoagulants and fibrinolytic activities. Am Rev Respir Dis 126:930–936Google Scholar
  18. 18.
  19. 19.
    Spannagl M, Hoffmann H, Siebeck M, Weipert J,Schrarhm W (1990) A preformed antithrombin III-heparin complex as potent inhibitor of activated clotting factors in endotoxin shock of the pig. Thromb Res (in press)Google Scholar
  20. 20.
    Sprengers ED, Kluft C (1987) Plasminogen activator inhibitors. Blood 69(2):381–387PubMedGoogle Scholar
  21. 21.
    Suffredini AF, Harpel PC, Parrilo JE (1989) Promotion and subsequent inhibition of plasminogen activation after administration of intravenous endotoxin to normal subjects. N Engl J Med 320:1165–1172PubMedCrossRefGoogle Scholar
  22. 22.
    Watkins J, Wild G (1985) The early diagnosis of impending coagulopathies following surgery and multiple trauma. Klin Wochenschr 63:1019–1027PubMedCrossRefGoogle Scholar
  23. 23.
    Witte J, Jochum M, Scherer R, Schramm W, Hochstrasser K, Fritz H (1982) Disturbances of selected plasma proteins in hyperdynamic septic shock. Intensive Care Med 8:251–222CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1991

Authors and Affiliations

  • W. Schramm
    • 1
  • M. Spannagl
    • 1
  1. 1.Central Medical ClinicLudwig Maximilians University MunichMunich 2Germany

Personalised recommendations