How to effectively prevent secondary fibrinolytic enhancement

The fibrinolytic system is the most important anticoagulation system in the body. During lysis, thrombin hydrolyzes fibrin, releasing soluble fibrin monomers, which, under the action of factor xIIIa, form stable cross-linked fibrin. In late stages of disseminated intravascular coagulation, the fibrinolytic system is activated due to intravascular coagulation, resulting in secondary fibrinolysis and more pronounced bleeding symptoms. How to effectively prevent secondary fibrinolysis enhancement? Supplementation of platelets and coagulation factors can provide a substrate for clotting in microthrombi and promote the development of DIC when blood is transfused or fibrinogen is given before heparin is used. However, the application of heparin can aggravate bleeding if the clotting factor is too low. Blood should be transfused (preferably fresh blood) or supplemented with fibrinogen, the latter raising plasma fibrinogen by 25 mg/dl per gram of preparation, with hemostatic effect only when fibrinogen concentration exceeds 100 mg/dl. The application of antifibrinolytic drugs in the early stage of DIC, fibrinolysis itself is a physiological protective mechanism, so the application of antifibrinolytic drugs is generally not advocated. Early use of anti-fibrinolytic drugs may worsen the condition. However, in the late stage of DIC when secondary fibrinolysis becomes the main contradiction of bleeding, antifibrinolytic drugs can be applied appropriately. These drugs should be applied under adequate heparin therapy. Only when there is no coagulation depletion but mainly secondary fibrinolysis continues, antifibrinolytic drugs should be applied alone. Commonly used drugs include 6 aminohexanoic acid (6EACA) 2-6g/d, intravenously, anti-fibrinolytic aromatic acid (p-carboxymethylarylamine, or PAMBA) 200-400mg/d, or hemostatic cyclic acid (AMCHA) 200-500mg/d, diluted with glucose solution and slowly administered intravenously or by injection. Some people advocate the use of peptidase when there is a large amount of fibrinolytic enzymes in the blood, and the trial dose is 80,000-100,000u, intravenous injection, and the dose is reduced after improvement, with 10,000u every 2 hours.