Hemostasis: the balance concept of procoagulant and inhibitor systems and use of the serial thrombin time (STT).

The balance concept between the procoagulant and inhibitor systems allows a perspective to better diagnose opposite hemostatic mechanisms, especially hemorrhagic tendencies as a result of intravascular consumption coagulopathy from pathologic fibrinolysis. Concepts presented are intended to provide a base for following the ever changing patient therapeutic response in the course of these sometimes fulminant conditions. A concise description of the Serial Thrombin Time test (STT) is presented as a rapid quantitative test for the differentiation of opposing mechanisms affecting hemostasis. Typical patient cases are presented to demonstrate the use of the STT in diagnosis, selection of therapeutic agents, and management of hemorrhagic episodes. Presented are cases of disseminated intravascular coagulation, primary fibrinolysis, coronary thrombosis, and hemophilia.