title: Disorders of hemostasis during the surgical management of severe necrotizing pancreatitis.
abstract: OBJECTIVE
  Several clinical studies of severe necrotizing pancreatitis (SNP) suggest profound activation of coagulation as well as activation of the fibrinolytic system. The aim of this study was to evaluate the hemostatic derangements in patients who were managed for SNP.
  
  
  METHODS
  Forty-one operated-on patients with SNP were analyzed regarding clinical outcome and activation of the coagulation systems. Serial measurement of coagulation, anticoagulation, and fibrinolysis parameters: prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, antithrombin III (AT III), protein C, plasminogen activator inhibitor-1 (PAI-1), d-dimer, alpha2-antiplasmin, and plasminogen were performed on days 1, 3, 5, 7, 10, and 14 after the initial operation. According to treatment outcome at the end of study, groups of 26 survivors and 15 nonsurvivors were compared.
  
  
  RESULTS
  Nonsurvivors had significantly lower levels of activity of protein C and AT III, and higher concentrations of d-dimer and PAI-1 than survivors. The other measured parameters did not show significant differences between the compared groups of patients.
  
  
  CONCLUSIONS
  Changes in protein C, AT III, d-dimer and PAI-1 levels indicate exhaustion of fibrinolysis and coagulation inhibitors in patients with poor outcome during the course of SNP.
authors.affiliation: Center of Emergency Surgery, Clinical Center of Serbia and School of Medicine, University of Belgrade, Belgrade, Serbia and Montenegro. dejanr@sbb.co.yu
authors.forename: Dejan
authors.initials: D
authors.lastname: Radenković
authors.forename: Djordje
authors.initials: D
authors.lastname: Bajec
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Karamarkovic
authors.forename: Branislav
authors.initials: B
authors.lastname: Stefanovic
authors.forename: Natasa
authors.initials: N
authors.lastname: Milic
authors.forename: Svetlana
authors.initials: S
authors.lastname: Ignjatović
authors.forename: Pavle
authors.initials: P
authors.lastname: Gregoric
authors.forename: Miroslav
authors.initials: M
authors.lastname: Milicevic
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000990:Antithrombin III / Q000032:analysis; D001779:Blood Coagulation Factors / Q000032:analysis; D001780:Blood Coagulation Tests; D001798:Blood Proteins / Q000032:analysis*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005342:Fibrinolysis; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D010180:Pancreatectomy / Q000379:methods*; D019283:Pancreatitis, Acute Necrotizing / Q000097:blood / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis; D011446:Prospective Studies; D020151:Protein C Deficiency / Q000097:blood / Q000209:etiology; D018805:Sepsis / Q000209:etiology / Q000401:mortality; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000401:mortality; D019851:Thrombophilia / Q000097:blood / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D001779:Blood Coagulation Factors; D001798:Blood Proteins; D005338:Fibrin Fibrinogen Degradation Products; D017395:Plasminogen Activator Inhibitor 1; C036309:fibrin fragment D; D000990:Antithrombin III