Levy Jerrold H, Iba Toshiaki
Juntendo Iji Zasshi. 2024 Dec 31;70(6):416-419. doi: 10.14789/ejmj.JMJ24-0035-P. eCollection 2024.
Trauma-induced coagulopathy (TIC) is characterized by dynamic changes in fibrinolysis, which can significantly impact patient outcomes. These changes typically manifest in two phases: hyperfibrinolysis followed by fibrinolysis suppression. In the early stages of TIC, there is often an overwhelming release of tissue plasminogen activator, which leads to excessive fibrinolysis. This hyperfibrinolytic state results in rapid clot breakdown, leading to uncontrolled bleeding and increased mortality. Following the hyperfibrinolytic phase, the fibrinolysis system is suppressed rapidly due to the increased production of plasminogen activator inhibitor-1, leading to fibrinolysis shutdown. This is a state where clot breakdown is significantly reduced, which can contribute to thromboembolic complications and multi-organ failure. Tranexamic acid, a plasmin inhibitor, effectively regulates hyperfibrinolysis as long as it is used in the appropriate hyperfibrinolytic phase. In summary, TIC involves a complex interplay between hyperfibrinolysis and fibrinolysis shutdown, with the balance between these states being crucial for patient survival. Effective management of TIC requires an understanding of these dynamic changes to tailor therapeutic interventions appropriately.
创伤性凝血病（TIC）的特征是纤维蛋白溶解的动态变化，这会对患者的预后产生重大影响。这些变化通常表现为两个阶段：高纤维蛋白溶解随后是纤维蛋白溶解抑制。在TIC的早期阶段，通常会大量释放组织纤溶酶原激活物，导致过度的纤维蛋白溶解。这种高纤维蛋白溶解状态会导致血栓迅速分解，导致出血失控和死亡率增加。在高纤维蛋白溶解阶段之后，由于纤溶酶原激活物抑制剂-1的产生增加，纤维蛋白溶解系统迅速受到抑制，导致纤维蛋白溶解停止。在这种状态下，血栓分解显著减少，这可能导致血栓栓塞并发症和多器官功能衰竭。氨甲环酸是一种纤溶酶抑制剂，只要在适当的高纤维蛋白溶解阶段使用，就能有效调节高纤维蛋白溶解。总之，TIC涉及高纤维蛋白溶解和纤维蛋白溶解停止之间的复杂相互作用，这些状态之间的平衡对患者的生存至关重要。TIC的有效管理需要了解这些动态变化，以便适当地调整治疗干预措施。
