By Gottfried Schmer
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Example text
On t h e o t h e r h a n d , t h e u s e of h e p a r i n i n a c a s e of t h e t y p e produced by p r i m a r y a c t i v a t i o n of t h e f i b r i n o l y t i c s y s t e m w i l l m e r e l y enhance t h e a n t i c o a g u l a n t p r o p e r t i e s of t h e f i b r i n o g e n - s p l i t products, f u n c t i o n s y n e r g i s t i c a l l y w i t h a n t i t h r o m b i n , and e x a c e r b a t e the hemorrhagic d i a t h e s i s . The a p p r o p r i a t e drug n o t o n l y must be g i v e n i n t r a v e n o u s l y i n a s u f f i c i e n t dosage so t h a t i t w i l l o v e r r i d e t h e t h r u s t of t h e p a t h o p h y s i o l o g i c p r o c e s s , but i t must be g i v e n c o n t i n u o u s l y .
Dr. Wolf: We a l s o h a v e t o keep i n mind t h a t w i t h many c o n d i t i o n s such a s p r e g n a n c y , o r c a n c e r , t h e f i b r i n o g e n b a s e l i n e i s h i g h so t h a t a normal f i b r i n o gen v a l u e of 200 t o 400 m i l l i g r a m s % found i n a p a t i e n t w i t h s u s p e c t e d DIC might s t i l l i n d i c a t e a dramat ic d e c r e a s e from a l e v e l of 700 t o 900 m i l l i g r a m s %. D r . H o u g i e : And of c o u r s e t h e F i - t e s t c a n be n e g a tive.
E . , a d r e n a l c o r t i c o n e c r o s i s , l i v e r i n f a r c t s , CNS i n f a r c t s . This may be p e c u l i a r i n t h e n e o n a t a l p e r i o d where one may i n d e e d h a v e low l e v e l s of f i b r i n o l y t i c a c t i v i t y and t h e y may h a v e an e x t e n t u a t i o n o r m a g n i f i c a t i o n of t h e c l o t t i n g process without the f i b r i n o l y t i c process. Could y o u comment on p o s s i b l e t h e r a p y f o r t h e t h r o m b o t i c problem once t h e t h r o m b i have formed?