Clinical Analysis of 22 Patients with Primary Fibrinolysis

Objective: To analysis the clinical features and therapy of acquired primary fibrinolysis.

Methods: The underlying diseases, clinical manifestations, laboratory findings, treatment and outcomes of 22 primary fibrinolysis were analyzed retrospectively.

Results: 22 patients were enrolled, 13 were male, and 9 were female. The median age was 54.9(17–77) years. The underlying diseases were ulcer of gastric-carcinoma bleeding, colorectal polypectomy by endoscope, intracranial tumor to get worse quickly, metanephric duct galeted by holmium laser+DJ tube implantation, herniorrhaphy of abdominal incision, gaster carcinosectomy, colon carcinosectomy, cerebral trauma and operation of cranium. Patients have bleeding and hemorrhage from surgical incisions or venipuncture or catheter sites in 1 to 7 days after trauma or surgery, with a disproportionately low level of fibrinogen (Fg), high level of tissue type plasminogen activator activity (t-PA) and a relatively normal of thrombin time (PT), activated partial thromboplastin time (APTT), thrombin time(TT), normal or nearly normal of platelet count. Diagnosis of primary fibrinolysis was established clearly, the patients were treated with plasma, cryoprecipitate, fibrinogen and fibrinolytic inhibitor PAMBA. Prognosis was quite good, 18/22 patients were cured.

Conclusion: Primary fibrinolysis may complicate various disorders, most of them are trauma, surgery, and malignancy. Bleeding and hemorrhage from surgical incisions or venipuncture or catheter sites is a predominant clinical feature. Low fibrinogen level with a normal or nearly normal platelet count is a predominant laboratory feature. We should differentiate primary fibrinolysis from the secondary fibrinolysis in DIC. Control of the primary disease, use fibrinolytic inhibitor, and replace depleted clotting factors with plasma, cryoprecipitate, fibrinogen, most of patients can be cured.