Blood Coagulation, Fibrinolysis and their Inhibitors Studies on Patients with Cancer

Fourteen parameters concerning coagulation, fibrinolysis and their inhibitors were measured in the 170 patients with various malignancies, including 68 cases of stomach cancer, 22 lung cancer, 21 colon and rectum cancer, 14 renal and urinary tract cancer, 9 primary hepatic cancer, 8 uterus and ovary cancer, 4 breast cancer and 19 others.Their parameters were platelet count, plasma fibrinogen level, prothrombin time, thrombotest, hepaplastintest, serial thrombin time, fibrinolytic split products, plasma plasminogen, ethanol gelation test, protamin sulfate test, cryofibrinogen, serum antithrombin III, serum α1 antitrypsin and serum α2 macroglobulin. Cases treated with anti-tumor agents were excluded in this study.Increased FDP in 52% (86 cases), prolonged serial thrombin time in 80%, positive paracoagulation tests and decreased antithrombin III were suggestive of increased activity of coagulation and fibrinolysis. The term of intravascular coagulation and fibrinolysis syndrome (ICF syndrome) was applied to the condition of increased FDP over 20μg/ml.And on the basis of fibrinogen (normal 200-400mg/dl) ICF syndrome was divided into 3 groups as following.Group I; hyperfibrinogenemiaPlatelet was increased, antithrombin III was decreased, plasminogen was normal or increased and paracoagulation tests tended to be positive. This conditions was defined as over compensated ICF syndrome, which was 16% (14 cases) of total ICF syndrome.Group II; normal fibrinogenemiaPlatelet was normal, antithrombin III was decreased, plasminogen was normal and paracoagulation test were less frequently positive. This condition was compensated ICF syndrome, which 59% (51 cases).Group III; hypofibrinogenemiaPlatelet was decreased, also antithrombin III and plasminogen were decreased. Paracoagulation tests were more frequently positive. This condition was defined as decompensated ICF syndrome, which was 25% (21 cases).Marked decrease of fibrinogen, platelet antithrombin III and plasminogen was observed in some patients in this group. DIC with bleeding tendency clinically observed belongs to this group.We concluded that it was significant to devide ICF syndrome due to malignancy into 3 groups on the basis of blood coagulation and fibrinnolysis for the management of patients with malignancy.