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Plasma 2-Antiplasmin Activity

Role in the Evaluation and Management of Fibrinolytic States and Other Bleeding Disorders

Eliot C. Williams, MD, PhD

Arch Intern Med. 1989;149(8):1769-1772.

Abstract
• To determine the clinical significance of acquired ₂-antiplasmin deficiency in patients with bleeding disorders, I reviewed the results of assays performed on 184 patients over a 4-year period. Thirty-two evaluable patients had ₂-antiplasmin activity levels of less than 50% of normal (defined as severe deficiency), and 35 patients had levels between 50% and 75% of normal (mild deficiency). Records of these patients and of 32 patients who had normal levels were reviewed. Most patients with severe ₂-antiplasmin deficiency had either liver disease or disseminated intravascular coagulation and/or fibrinolysis, or both. There was a high incidence of severe ₂-antiplasmin deficiency among patients with acute promyelocytic leukemia. Five patients with pathologic bleeding had no identifiable coagulation abnormalities other than ₂-antiplasmin deficiency. The group with severe ₂-antiplasmin deficiency had a significantly higher incidence of life-threatening or fatal bleeding and the most striking laboratory evidence of hyperfibrinolysis. Using the presence of severe ₂-antiplasmin deficiency as an indication for therapy, -aminocaproic acid treatment was associated with cessation of life-threatening bleeding in 8 of 11 patients.

(Arch Intern Med. 1989;149:1769-1772)

Author Affiliations
From the Departments of Medicine and Pathology and Laboratory Medicine, University of Wisconsin, Madison.

Footnotes
Accepted for publication December 23, 1988.

Reprint requests to Department of Medicine, 1300 University Ave, Madison, WI 53706 (Dr Williams).

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