Clinical indications for intensive care medicine

The pathogenic situations in which antifibrinolytic drug therapy should be considered are listed in Table 1... When systemic fibrinolysis is suspected, it is important to obtain confirmatory laboratory evidence of hyperfibrinolysis by a screening test before starting therapy. In these situations the euglobin lysis time will be appreciably shortened (the normal range is usually approximately 70 to 300 min) or excessive lysis can be demonstrated by a fibrin plate assay. Acute DIC must also be excluded, as antifibrinolytic therapy is usually contraindicated in this condition. It is also useful to monitor the fibrinogen level, as a reduced level (below 1.0 g/l) due to fibrinogenolysis may require additional specific replacement therapy. In most of the clinical situations listed, antifibrinolytic therapy alone is unlikely to control bleeding completely and additional therapeutic hemostatic measures will be required.

Table 1 Clinical indications for antifibrinolytic therapy

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