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Editorials

Bleeding That Won’t Stop

^a Harrison Department of Surgical Research, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
^b The Sol Sherry Thrombosis Research Center, Hematology Division, Department of Medicine, Temple University, Philadelphia, Pennsylvania

^_* Address correspondence to Dr Edmunds, 3440 Market St, Suite 306, Philadelphia, PA 19104-3325 (Email: hank.edmunds@uphs.upenn.edu).

The first 20% of the full text of this article appears below.

Bleeding that will not stop is often a consumptive coagulopathy, which may be defined as the simultaneous generation of thrombin—the enzyme that cleaves fibrinogen to fibrin, and plasmin, the enzyme that cleaves fibrin. This condition occurs in disseminated intravascular coagulation (DIC), which may complicate systemic sepsis or massive trauma. To varying degrees, consumptive coagulopathy also occurs in cardiac operations using cardiopulmonary bypass [1, 2].

Thrombin normally acts locally at sites of injury and does not circulate because it is rapidly inhibited by antithrombin. Antithrombin is present at relatively high concentration in plasma. However, during cardiac surgery with cardiopulmonary bypass, thrombin is steadily produced and circulated [2]. Direct measurement of thrombin is very difficult, but the cleavage of prothrombin to thrombin generates a fragment, F1.2, which can be measured in approximately 1 hour by enzyme linked immunosorbent assay (ELISA). F1.2 progressively increases during cardiac operations using cardiopulmonary bypass, and it documents the continuous generation of thrombin [2]. Heparin does not inhibit thrombin generation; it inhibits thrombin after it is formed and is not able to inhibit thrombin trapped in fibrin clots [. . . [Full Text of this Article]