ABSTRACT
Objective:To analyze the effect of anticoagulant or antiplatelet drugs on bleeding and cardio-cerebral vascular events in perioperative period of catherization for peritoneal dialysis.Methods:The clinical data of patients undergoing peritoneal dialysis catheterization in Peking University Third Hospital from July 1, 2010 to December 31, 2020 were collected and analyzed retrospectively. The patients were divided into drugs discontinuation group and drugs continuation group according to whether the anticoagulant drugs or antiplatelet drugs were discontinued or not. Baseline clinical data and bleeding and cardio-cerebral events after surgery were compared between the two groups. Multivariate logistic regression model was used to analyze the influencing factors for bleeding and cardio-cerebral events.Results:A total of 57 patients were included in the study, with 34 males and 23 females. The age was (67.37±13.93) years old (range from 27 to 97 years old). There were 37 patients in drugs discontinuation group and 20 patients in drugs continuation group. The proportions of acute myocardial infarction events in drugs continuation group were higher than those in drugs discontinuation group in 3 months and 6 months before surgery (10/20 vs 3/37, χ2=10.671, P=0.001; 11/20 vs 3/37, χ2=12.980, P<0.001 respectively). The median drugs discontinuation time was 5.0(2.0, 14.0) d (range from 1 to 30 d) before surgery, and median restore medication time was 4.0(3.0, 7.0) d (range from 1 to 14 d) after surgery in drugs discontinuation group. There was no significant difference in the proportion of bleeding (10/37 vs 8/20, χ2=1.011, P=0.315) and cardio-cerebral events (4/37 vs 0/20, χ2=0.964, P=0.326) between drugs discontinuation group and drugs continuation group within 2 weeks after surgery. The results of multivariate logistic regression analysis showed that drugs discontinuation before surgery was not an independent influencing factor for bleeding events ( OR=0.656, 95% CI 0.195-2.206, P=0.496), however combination of aspirin and clopidogrel before surgery was an independent influencing factor for bleeding events ( OR=4.038, 95% CI 1.044-15.626, P=0.043). All cardio-cerebral events (4 cases) happened in drugs discontinuation group, and myocardial angina in 6 months before surgery ( OR=9.764, 95% CI 0.928-102.682, P=0.058) and increased serum calcium concentration ( OR=1.491, 95% CI 0.976-2.278, P=0.065) were related with an elevated trend for cardio-cerebral events. Conclusions:Whether anticoagulant or antiplatelet drugs are discontinued before catherization surgery for peritoneal dialysis is not an independent influencing factor for bleeding events after surgery. The risk of postoperative bleeding in patients using combination of aspirin and clopidogrel should be paid attention. Myocardial angina in 6 months before surgery and higher serum calcium are related with an elevated trend for cardio-cerebral events after drugs discontinuation.
ABSTRACT
Objective To investigate the safety of argatroban in vertebral artery stenting and its effect on postoperative restenosis.Methods From January 2013 to September 2017,patients undergoing vertebral artery stenting in the Department of Neurology,Jinling Hospital were enrolled prospectively.They were divided into agatraban group and heparin group by random number table method.The argatroban group received argatroban anticoagulation during the procedure,and was continuously used for 5 d after procedure;while the heparin group underwent heparin anticoagulation during the procedure,and used saline as placebo after procedure.Clinical follow-up was performed at 1,3,and 6 months after procedure.Digital subtraction angiography,CT angiography,or magnetic resonance angiography were performed at 6 months to evaluate the restenosis of the treated blood vessels.The primary endpoints included intraoperative safety,in-stent restenosis after procedure,and any clinical events that occurred during the follow-up period,including stroke,cardiovascular events,and death.Major safety events included bleeding from various organs,allergic reactions,liver dysfunction,and embolism events.Kaplan-Meier survival curve was used to evaluate the incidence of vascular events during the follow-up period.Results A total of 105 patients were enrolled in the analysis,including 53 in the argatroban group and 52 in the heparin group.During the periprocedural period,no hemorrhagic events,allergic reactions,liver dysfunction or embolism events occurred in both groups.There were no significant differences in preoperative vertebral artery stenosis degree,postoperative residual stenosis degree,and stenosis degree at 6 months after procedure between the two groups,but the increase of stent stenosis at 6 months after procedure in the agatroban group was significantly lower than that in the heparin group (13.56％ ±26.41％ vs.4.25％ ± 15.76％;P =0.031).There was no significant difference in the incidence of stroke recurrence (P =1.000) and clinical events (P=0.739) between the two groups during the long-term follow-up period.Conclusions It is safe to use agatraban anticoagulant therapy in the vertebral artery stenting.Continuous use of agatraban anticoagulation after procedure may effectively reduce the increase of stent stenosis at 6 months after procedure.
ABSTRACT
Objective@#To investigate the safety of argatroban in vertebral artery stenting and its effect on postoperative restenosis.@*Methods@#From January 2013 to September 2017, patients undergoing vertebral artery stenting in the Department of Neurology, Jinling Hospital were enrolled prospectively. They were divided into agatraban group and heparin group by random number table method. The argatroban group received argatroban anticoagulation during the procedure, and was continuously used for 5 d after procedure; while the heparin group underwent heparin anticoagulation during the procedure, and used saline as placebo after procedure. Clinical follow-up was performed at 1, 3, and 6 months after procedure. Digital subtraction angiography, CT angiography, or magnetic resonance angiography were performed at 6 months to evaluate the restenosis of the treated blood vessels. The primary endpoints included intraoperative safety, in-stent restenosis after procedure, and any clinical events that occurred during the follow-up period, including stroke, cardiovascular events, and death. Major safety events included bleeding from various organs, allergic reactions, liver dysfunction, and embolism events. Kaplan-Meier survival curve was used to evaluate the incidence of vascular events during the follow-up period.@*Results@#A total of 105 patients were enrolled in the analysis, including 53 in the argatroban group and 52 in the heparin group. During the periprocedural period, no hemorrhagic events, allergic reactions, liver dysfunction or embolism events occurred in both groups. There were no significant differences in preoperative vertebral artery stenosis degree, postoperative residual stenosis degree, and stenosis degree at 6 months after procedure between the two groups, but the increase of stent stenosis at 6 months after procedure in the agatroban group was significantly lower than that in the heparin group (13.56%±26.41% vs. 4.25%±15.76%; P=0.031). There was no significant difference in the incidence of stroke recurrence (P=1.000) and clinical events (P=0.739) between the two groups during the long-term follow-up period.@*Conclusions@#It is safe to use agatraban anticoagulant therapy in the vertebral artery stenting. Continuous use of agatraban anticoagulation after procedure may effectively reduce the increase of stent stenosis at 6 months after procedure.
ABSTRACT
Objective@#The aim of this study is to investigate the variation tendency of coagulation and fibrinolysis biomarkers in cancer patients and to explore the effect of these biomarkers for the diagnosis of thrombosis in cancer patients.@*Methods@#171 cancer patients admitted to hospital from September 2017 to July 2019 were enrolled in the study, including 40 cancer patients undergoing surgery, 108 cancer patients without surgery in control group and 23 cancer patients with thrombus. New coagulation and fibrinolysis biomarkers, TM (Thrombomodulin), TAT (Thrombin -antithrombin complex), PIC (Plasmin alpha 2-plasmin inhibitor complex) and t-PAI·C (Tissue plasminogen activator-plasminogen activator inhibitor-1 complex), were tested in every patient. In addition, these new biomarkers are compared with D-dimer.@*Results@#A statistically difference was available on the value of TAT, TM, PIC, t-PAIC, between postoperative cancer patients group and control group (P<0.05, respectively). TAT, TM and PIC in thrombosis cancer group were higher than those in non-thrombosis cancer group (P<0.05; respectively). ROC was used to evaluate the performance of D-dimer, TAT and PIC on thrombosis in cancer patients. The results showed that the AUC of PIC and TAT were both higher than D-dimer (0.871 vs. 0.619; 0.788 vs. 0.619). The specificity of PIC alone was higher than that of D-dimer (91.9% vs. 82.4%), and the sensitivity of PIC and TAT alone was higher than that of D-dimer (73.9% vs. 47.8%, 73.9% vs. 47.8%, respectively).@*Conclusions@#The activity of coagulation and fibrinolysis in cancer patients was abnormally enhanced. TAT and PIC were better than D-dimer for the diagnosis of thrombosis in cancer patients.
ABSTRACT
Objective The aim of this study is to investigate the variation tendency of coagulation and fibrinolysis biomarkers in cancer patients and to explore the effect of these biomarkers for the diagnosis of thrombosis in cancer patients. Methods 171 cancer patients admitted to hospital from September 2017 to July 2019 were enrolled in the study, including 40 cancer patients undergoing surgery, 108 cancer patients without surgery in control group and 23 cancer patients with thrombus. New coagulation and fibrinolysis biomarkers, TM (Thrombomodulin), TAT (Thrombin-antithrombin complex), PIC (Plasmin alpha 2-plasmin inhibitor complex) and t-PAI · C (Tissue plasminogen activator-plasminogen activator inhibitor-1 complex), were tested in every patient. In addition, these new biomarkers are compared with D-dimer. Results A statistically difference was available on the value of TAT, TM, PIC, t-PAIC, between postoperative cancer patients group and control group (P<0.05, respectively). TAT, TM and PIC in thrombosis cancer group were higher than those in non-thrombosis cancer group (P<0.05;respectively). ROC was used to evaluate the performance of D-dimer, TAT and PIC on thrombosis in cancer patients. The results showed that the AUC of PIC and TAT were both higher than D-dimer (0.871 vs. 0.619;0.788 vs. 0.619). The specificity of PIC alone was higher than that of D-dimer(91.9％ vs. 82.4％), and the sensitivity of PIC and TAT alone was higher than that of D-dimer(73.9％ vs. 47.8％, 73.9％ vs. 47.8％, respectively). Conclusions The activity of coagulation and fibrinolysis in cancer patients was abnormally enhanced. TAT and PIC were better than D-dimer for the diagnosis of thrombosis in cancer patients.
ABSTRACT
Background: Extracorporeal membrane oxygenation (ECMO) is used with increasing frequency in patients with respiratory and cardiac failure. The achievement of an adequate anticoagulation is critical to avoid patient and circuit complications. Aim: To assess the feasibility and safety of anticoagulation with bivalirudin, as an alternative to unfractionated heparin (UFH), in patient with ECMO. Material and Methods: Observational study, which included all patients receiving anticoagulation with bivalirudin during ECMO, according to a standardized protocol, between august 2015 to May 2016. Results: Bivalirudin was used in 13 out 70 patients connected to ECMO. Ten procedures were for cardiac support and three for respiratory support. Mortality was 43%. ECMO lasted 31 ± 31 days. The time of UFH use before changing to bivalirudin was 7 ± 7 days. The reasons to change to bivalirudin were inadequate levels of partial thromboplastin time (PTT) in nine patients, and heparin induced thrombocytopenia (HIT) in four patients. The time of bivalirudin use was 24 ± 33 days. Per patient, a mean of 2.7 ± 4 oxygenators were changed. These had a useful life of 11.4 and 19.1 days during UFH and bivalirudin use, respectively. The mean bivalirudin dose was 0.08 ± 0.04 mg/kg/h. There was no significant bleeding, thrombosis or circuit obstruction during its use. PTT levels (p < 0.01) and platelet count (p < 0.01) increased significantly after the start of bivalirudin use in patients with UHF resistance and HIT, respectively. Conclusions: Bivalirudin was a safe and efficient drug for anticoagulation during ECMO. It is important to have an alternative drug for anticoagulation in ECMO patients.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Young Adult , Peptide Fragments/blood , Extracorporeal Membrane Oxygenation , Hirudins/blood , Anticoagulants/blood , Partial Thromboplastin Time , Peptide Fragments/administration & dosage , Platelet Count , Recombinant Proteins/administration & dosage , Recombinant Proteins/blood , Heparin/adverse effects , Feasibility Studies , Hirudins/administration & dosage , Anticoagulants/administration & dosageABSTRACT
BACKGROUND/AIMS: The risk of gastrointestinal (GI) bleeding with dabigatran when compared to warfarin has been controversial in the literature. The aim of our study was to assess this risk with the use of dabigatran. METHODS: We examined the medical records of patients who were started on dabigatran or warfarin from October 2010 to October 2012. The study was conducted in two hospitals. RESULTS: A total of 417 patients were included (208 dabigatran vs. 209 warfarin). GI bleeding occurred in 10 patients (4.8%) in the dabigatran group compared to 21 patients (10.1%) in the warfarin group (p=0.0375). Multivariate analysis showed that patients who were on dabigatran for 100 days (p=0.0007). The odds of GI bleeding in patients who were on dabigatran for 100 days. The incidence of GI bleeding in patients >65 years old was higher than in those 65 years, and a history of previous GI bleeding.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Age Factors , Anticoagulants/adverse effects , Atrial Fibrillation/drug therapy , Dabigatran/adverse effects , Gastrointestinal Hemorrhage/chemically induced , Incidence , Kaplan-Meier Estimate , Multivariate Analysis , Odds Ratio , Retrospective Studies , Risk Factors , Warfarin/adverse effectsABSTRACT
Atrial fibrillation (AF)is a strong risk factor for ischemic cerebral stroke.Some inherent defects of War-farin limit its clinic application,which accelerates research and development of new oral anticoagulants,such as Dabigatran,Apixaban,Rivaroxaban and Edoxaban etc..This article made an overview for these.
ABSTRACT
BACKGROUND/AIMS: To evaluate the usefulness and safety of treating disseminated intravascular coagulation (DIC) complicating cholangitis primarily with antithrombin (AT) and thrombomodulin (rTM). METHODS: A DIC treatment algorithm was determined on the basis of plasma AT III levels at the time of DIC diagnosis and DIC score changes on treatment day 3. Laboratory data and DIC scores were assessed prospectively at 2-day intervals. RESULTS: DIC reversal rates >75% were attained on day 7. In the DIC reversal group, statistically significant differences from baseline were observed in interleukin-6 and C-reactive protein levels within 5 days. Patients with no DIC score improvements after treatment with AT alone experienced slow improvement on a subsequent combination therapy with rTM. Although a subgroup with biliary drainage showed greater improvement in DIC scores than did the nondrainage subgroup, the mean DIC score showed improvement even in the nondrainage subgroup alone. Gastric cancer bleeding that was treated conservatively occurred in one patient. As for day 28 outcomes, three patients died from concurrent malignancies. CONCLUSIONS: Although this algorithm was found to be useful and safe for DIC patients with cholangitis, it may be better to administer rTM and AT simultaneously from day 1 if the plasma AT III level is less than 70%.
Subject(s)
Humans , Antithrombin III , Antithrombins , C-Reactive Protein , Cholangitis , Dacarbazine , Disseminated Intravascular Coagulation , Drainage , Hemorrhage , Interleukin-6 , Plasma , Prospective Studies , Stomach Neoplasms , ThrombomodulinABSTRACT
Objective To investigate the relationship between the plasma levels of ET-1,TAT,and hs-CRP and slow coronary flow syndrome (SCFS),and explore effects of coronary endothelial function,coagulation function,and inflammatory reaction on blood flow of coronary artery.Methods A total of 400 cases with normal blood flow of coronary artery by coronary angiogram was randomly selected.The coronary flow patterns were determined by corrected thrombolysis in myocardial infarction frame count method (cT-FC).Among them,45 cases whose average cTFC more than 27 were assigned as SCFS group,the other 45 cases no SCFS.Plasma levels of ET-1,TAT and hs-CRPwere examined with enzyme-linked immunosorbent assay (ELISA),and were compared between two groups.Moreover,multivariate analysis evaluating predictors of SCFS was performed with regression test.Results No statistical difference was found between two groups concerning the gender,history of hypertension,diabetes mellitus,and cigarette alcohol percentage..The plasma level of HDL in SCFS group was lower than that of no SCFS [(1.22 ± 0.42) mmol/L vs (1.44±0.34) mmol/L,t =-2.731,P ＜0.01],but the plasma level of glucose in the former was higher than that of the latter [(5.68 ±0.62) mmol/L vs (5.10 ±0.84) mmol/L,t =3.727,P ＜0.01].However,Plasma levels of ET-1,TAT and hs-CRP in SCFS were higher than that of no SCFS [(94.3 ± 16.78) ng/Lvs (83.5±12.53) ng/L,t =3.051,P ＜0.01;(12.96±3.24)μg/Lvs (8.76 ±2.64)μg/L,t =5.945,P ＜ 0.01 ; (2.48 ± 0.35) μg/L vs (1.38 ± 0.46) μg/L,t =11.259,P ＜ 0.01].Furthermore,Logistic regression analysis showed that ET-1,TAT and hs-CRP were risk factors for SCFS (OR ＞ 1.22).Conclusions Due to coronary endothelial dysfunction,endothelial inflammatory reaction,and activated coagulation function,slow coronary flow of coronary artery occurs.
ABSTRACT
O conceito da cascata da coagulação descreve as interações bioquímicas dos fatores da coagulação, entretanto, tem falhado como um modelo do processo hemostático in vivo. A hemostasia requer a formação de um tampão de plaquetas e fibrina no local da lesão vascular, bem como a permanência de substâncias procoagulantes ativadas nesse processo no sítio da lesão. O controle da coagulação sanguínea é realizado por meio de reações procoagulantes em superfícies celulares específicas e localizadas, evitando a propagação da coagulação no sistema vascular. Uma análise crítica do papel das células no processo hemostático permite a construção de um modelo da coagulação que melhor explica hemorragias e tromboses in vivo. O modelo da coagulação baseado em superfícies celulares substitui a tradicional hipótese da "cascata" e propõe a ativação do processo de coagulação sobre diferentes superfícies celulares em quatro fases que se sobrepõem: iniciação, amplificação, propagação e finalização. O modelo baseado em superfícies celulares permite um maior entendimento de como a hemostasia funciona in vivo e esclarece o mecanismo fisiopatológico de certos distúrbios da coagulação.
The concept of a coagulation cascade describes the biochemical interactions of the coagulation factors, but it is flawed as a model of the in vivo hemostatic process. Hemostasis requires both platelet and fibrin plug formation at the site of vessel injury and that the procoagulant substances activated in this process remain at the site of injury. This control of blood coagulation is accomplished as the procoagulant reactions only exist on specific cell surfaces to keep coagulation from spreading throughout the vascular system. A model of coagulation that better explains bleeding and thrombosis in vivo created after considering the critical role of cells. The cellbased model of hemostasis replaces the traditional "cascade" hypothesis, and proposes that coagulation takes place on different cell surfaces in four overlapping steps: initiation, amplification, propagation and termination. The cell-based model allows a more thorough understanding of how hemostasis works in vivo, and sheds light on the pathophysiological mechanism for certain coagulation disorder.
Subject(s)
Humans , Anticoagulants , Antithrombins , Blood Coagulation , Blood Coagulation Factors , Hemostasis , Protein C , Protein S , Blood Platelets/metabolism , Thromboplastin , Blood Coagulation Disorders/physiopathologyABSTRACT
Objective To investigate the inhibitory effects of Argatroban on the instant bloodmediated inflammatory reaction(IBMIR)after islet transplantation.Methods Rat islets were isolated and purified rat islets,and were divided into blank control group,control group and experimental group.In the control group,the blood and the islets were directly mixed,and in the experimental group the Argatroban was added to the mixture based on the control group.while the blank control group was added with blood alone without the islets.Each group was reacted at 37℃for 60min,and then the content was filtered through trap valve of 70 μm.The residual thrombus and tissues were filtered by the trap valve in both the experimental and control groups,detected by the thinprep cytologic test(TCT),and the filtrate received blood routine test,and the function of islet was determined using insulin releasing test.Results The number of blood platelets,white blood cells,mononuclear cells,and lymphocytes percentage in the experimental group were significantly higher than in the control group after 60 min(P＜0.05).Under the environment of the high and low concentrations of glucose,the insulin release in experimental group was significantly increased as compared with the control group,and the insulin release index of former was 2.25±0.18,significantly higher than that of the latter 3.36±0.18(P＜0.05).The residual thrombus and tissues had few islet cells in the control group,the structure was damaged seriously,the capsule was not intact,and there were a large mumber of micro-thrombosis around the islets formed by red blood cells.But there were a large number of islet cells in the experimental group.the structure was intact in a mass,and no obvious micro-thrombosis around the islets was found.Conclusion Argatroban can effectively inhibit IBMIR in vitro,and alleviate the damage to the islet cells.
ABSTRACT
Objective To measure D-Dimer(DD) ,thrombin-antithrombin complex(TAT), lasmin-antiplasrain complex(PAP) and protein C(PC) in ARDS,to find the clinical significance of them,discuss the objective base in the early diagnosis of ARDS in the lab, and offer the serologic bases in the treatment and prognosis of ARDS.Methods 105 patients of ARDS were selected as the study group, and 105 people were selected as the control group, all of whom were healthy with no thrombus diseases. The venous blood of everyone in both groups was sampied,in order to take a quantitative determination of plasma prothrombin time(PT), prothrombin time(TT), kadin partial thromboplastin time(APTT), the amount of blood platelet, DD, TAT, PAP, PC. Results Serum concentratation of D-D, TAT, PAP was significantly higher in patients in ARDS group than that in control group(P＜0.01).Serum concentratation of PC was significantly lower in patients in ARDS group than that in control group (P＜0.01). Conclusion Measuring the concentration of DD, TAT, PAP and PC was very important, which not only did good to the early diagnosis of ARDS,but also had a clinic value.
ABSTRACT
Objective To study the clinical significance of molecular markers and routine coagulation tests in patients with cerebral infarction and to set up a serial programs of laboratory diagnosis,monitoring and treatment of cerebral infarction.Methods Prothrombin fragment 1+2(F1+2),thrombin antithrombin III complex(TAT), D-dimer(D-D),Von willebrand Factor(vWF),antithrombin(AT), protein C(PC),prothrombin time(PT),activated partial thromboplastin time(APTT) and thrombin time (TT) were determined in 90 patients with cerebral infarction and 60 normal control subjects.Results The levels of F1+2,TAT,D-D,vWF were significantly higher in patients with cerebral infarction than that in control subjects. But the levels of PC,AT,PT,APTT,TT in patients with cerebral infarction were no different from that in control subjects.Conclusion There were hypercoagulable states in patients with cerebral infarction.The activity of prothrombin is higher, thrombin is generated more, the activity of fibrinolysis is higher too, but anticoagulation system is not sufficiently activated .Meanwhile, perhaps endothelial lesion would be the main role of coagulation system activating and pathogenesis.Molecular markers such as F1+2,TAT,D-D,VWF can be as diagnositic signs but routine coagulable tests can not display the hypercoagulable states in patients with cerebral infarction.
ABSTRACT
Objective To investigate the hemostatic and coagulative variations during orthotopic liver transplantation (OLT).Method The blood platelet count, coagulant and anti-coagulant functions were assessed pre- and intra-operation of OLT.Results During the operation, activated partial thromboplastin time (aPTT) and prothrombin time (PT) were prolonged, platelet count (PLT), activities of most of the coagulation factors and levels of antithrombin (AT), plasminogen (PLG), plasminogen activator inhibitor-1 (PAI-1) and ?2 -antiplasmin (?2-AP) were reduced, while the levels of tissue plasminogen activator (t-PA), plasmin-?2-antiplasmin complex (PAP) and thrombin-antithrombin complex (TAT) were increased. The variations in the neohepatic phase were more significant than that in the pre-operation phase. Conclusion In the entire process of OLT operation, the coagulant and anti-coagulant functions were decreased, and the fibrinolytic functions were sthenic in the anhepatic phase and the neohepatic phase.
ABSTRACT
Objective To investigate the relationship between the hemostatic coagulation markers of pr ethrombosis state and pregnancy induced hypertension(PIH). Methods Forty-five PIH patients and 20 control patients were studied. P-selectin, pro thrombin fragments 1+2 (F1+2), D-dimers(D-D) and plasmin-antiplasmin complex (PAP) were measured by enzyme linked immunosorbent assay. Antithrombin activity (AT: A) was measured by chromogenic peptide substrate assay. Results (1) The P-selectin level of pre-delivery in moderate and severe PIH patients w as (66?24)?g/L and (80?30)?g/L, it was (49?15)?g/L in the control group ( both P
ABSTRACT
Objective To evaluate the dynamic change of the antithrombase and fibrinolytic function in the critical patients.Methods Eighty-seven patients hospitalized in ICU were studied. According to the clinical manifestation, all patients were divided into systemic inflammatory response syndrome (SIRS) group ( n = 68) and non-SIRS group ( n = 19), or multiple organ dysfunction syndrome (MODS) group ( n = 37) and non-MODS group (n = 50) respectively. Thirty-one healthy volunteers were selected for control in the same period. The intravenous blood samples were taken 1,3 and 5 days after ICU admission to measure platelet,count (PLT) , and the plasma levels of antithrombase activity (AT: A), plasminogen activity (PLG: A), fibrinogen (FIB) and D-dimer (D-D) concentrations.Results AT: A, PLG: A and PLT were lower and FIB and D-D levels higher in all patients than control levels (P