Association of fibrinolytic tests with outcome of acute upper-gastrointestinal-tract bleeding.

Endogenous fibrinolysis may play a part in acute upper-gastrointestinal-tract bleeding by causing digestion of haemostatic plugs. We assessed the predictive value of fibrinolytic tests for hospital outcome in a prospective study of 122 patients with acute upper-gastrointestinal-tract bleeding who underwent endoscopy. Serum fibrin degradation products (FDP) were above the normal range in 32% (95% CI 21-44%) of patients who survived and did not require transfusion or surgery, in 53% (37-69%) of patients who survived without surgery but required transfusion, and in 100% (82-100%) of patients who required surgery or died. Multivariate analysis showed that after adjustment for the effects of established risk factors (age, pulse rate, blood pressure, haemoglobin, site of bleeding, and stigmata of active bleeding at endoscopy), serum FDP was a powerful independent predictor of outcome (p = 0.003). Doubling of serum FDP was associated with a 59% increase in the risk of a poor outcome (95% CI 14-120%). These findings are consistent with roles for endogenous fibrinolysis in gastrointestinal-tract bleeding, for fibrinolytic tests in prediction of adverse outcome, and for fibrinolytic inhibitors in treatment.