Hypercoagulability In Acute Esophageal Variceal Bleeding

Abstract

In 15 patients with acute esophageal bleeding selected parameters of hypercoagulability were determined at frequent intervals during intensive care treatment. Estimation of soluble fibrin monomer complexes (SFMC) by gel filtration of plasma samples which were purified by ß-alanine precipitation allowed the determination of the relative amount of SFMC (percentage of SFMC in relation to the total fibrinogen content in plasma). Antithrombin III (AT III) activity was determined photometrically using the chromogenic substance S-2238 and immunologically by one dimensional immunelectrophoresis. Fibrin split products (FSP) were estimated by the staphylococcal clumping test.Increased levels of SFMC were observed in 10 out of 15 patients on admission. A further increase was noted in most patients in whom bleeding persisted and who needed replacement therapy with blood components. Substitution with prothrombin complex concentrates induced acute DIC in two patients with levels of SFMC up to 24 %. AT III was decreased to levels of 30-50 % in 8 patients during the acute illness. A discrepancy between the functional and immunological AT III value was noted in some instances but more often both values were very low.High levels of SFMC in addition to levels of AT III of less than 50 % reflect a serious state of hypercoagulability with a very poor prognosis for the patients. Clotting factor concentrates may be especially thrombogenic in these patients with impaired clearing activity. Fresh frozen plasma and AT III concentrates provide an appropriate source of the most important clotting factors.