Plasma levels of thrombin activatable fibrinolysis inhibitor (TAFI) and total plasminogen activator inhibitor-1 (PAI-1) and tissue type plasminogen activator (tPA)/PAI-1 complex in patients with disseminated intravascular coagulation (DIC) to examine the relationship between hypofibrinolysis and the pathogenesis with DIC. We examined 39 patients with DIC, 23 with pre-DIC, 181 without DIC and 17 healthy volunteers. Both plasma levels of total PAI-1 and tPA/PAI-1 complex were significantly high in patients with DIC. Those levels were also high in patients with organ failure, especially sepsis. Both TAFI activity and antigen levels in the plasma were significantly low in patients with DIC. TAFI activity in plasma was correlated with TAFI antigen. TAFI activity and antigen levels were negatively correlated with TAT and D-dimer. The TAFI activity in plasma was significantly low in patients with infection and in those with organ failure, suggesting that TAFI may play an important role in the mechanism of organ failure in DIC-associated sepsis. Regulation of fibrinolysis by TAFI and PAI-1 may play an important role in the pathogenesis of DIC and organ failure.