Patients with abdominal aortic aneurysm (AAA) experience impaired balance between fibrinolysis and coagulation, manifested by increased prothrombotic tendency and intensified inflammatory processes. The aim of this study was to evaluate the TAFI activity level (thrombin activatable fibrinolysis inhibitor) in the plasma of AAA patients. Plasma levels of PAI-1 (plasminogen activator inhibitor type 1), urokinase-type plasminogen activator and uPAR (urokinase-type plasminogen activator receptor) were measured as markers of fibrinolytic activity. The study showed that the activity of the thrombin-activatable fibrinolysis inhibitor in the plasma of AAA patients was significantly lower than in the plasma of the control individuals (64.6 ± 10.1 vs. 54.2 ± 10.9%, P < 0.0001). TAFI activity positively correlated with the white blood cell count (r = 0.486, P < 0.005). The uPAR concentration in the AAA patients was statistically significantly higher than in the control group and positively correlated with TAFI activity (r = 0.409, P = 0.02). The levels of PAI-1 and D-dimers (fibrin fragments) were significantly higher in patients with AAA than in the control group (44.3 ± 17.5 vs. 21.7 ± 8.7 ng/ml and 1869.6 ± 1490.1 vs. 181.5 ± 188.6 ng/ml, respectively). Lowered activity of the fibrinolysis inhibitor TAFI may heighten the blood fibrinolytic potential in AAA patients and contribute to the development of comorbidities. Therefore, TAFI participation in AAA pathogenesis cannot be excluded.

Spinal epidural hematoma (SEH) is blood accumulation between the dura mater of the spinal canal and the bone of the vertebrae. It is estimated to be an extremely rare incidence, affecting approximately 0.1 of 100,000 patients. When the suspected cause is a sport-related injury in the majority of cases it affects the trauma region. The aim of this case report was to outline the case of a 60-year-old man who was admitted to the Emergency Department due to acute, severe pain in the lumbar region which lasted 30 min. It occurred that 54 h prior to the admission, he suffered a head injury due to sport-related trauma during recreational skiing. When waiting for the laboratory and imaging test results the patient developed bilateral paralysis of the lower limbs. The MR examination results showed SEH at the level Th9-L1; therefore, immediate neurosurgical laminectomy was performed. After 36 months of rehabilitation, the patient can walk independently. In summary, SEH without immediate and appropriate treatment is linked with very poor clinical outcome. Moreover, a high mortality rate of 7% and the fact that more than half of patients do not return to full physical health incentives its inclusion in differential diagnosis every time when symptoms of spinal cord involvement are found. Furthermore, delayed aftermath in the form of paresis of the lower limbs requires long-term and intensive physical rehabilitation.