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Consumption coagulopathy

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Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.

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Abstract

First described by McKay [1], disseminated intravascular coagulation (DIC) represents a diagnostic and therapeutic challenge for the clinician. DIC is not a disease or a symptom, but rather a poorly defined syndrome with a widely variable intensity, often complicating a diversity of severe disorders that are themselves related to extensive morbidity and mortality. Despite advances in knowledge, the mortality rate remains high (30% - 50%) [2]. Thrombin, the end product of activation, is the key enzyme responsible for this syndrome. Increased thrombin generation can occur systemically as in sepsis or in burned patients, or can be localized to one organ, becoming generalized only at the end, as in necrotic hemorrhagic pancreatitis and obstetric complications. The outcome of any activation depends on the rate and extent of the activation, ability of the physiological antithrombotic processes to control thrombosis, specific diseases that activate the haemostasis, conditions of other organs and host response to these noxius stimuli. A sudden onset of the activating stimulus, as in septic shock or in a placental abruption, leads to acute DIC, whereas a chronic process is evident secondary to a gradually developing stimulus, as in patients with cancer, large aortic aneurysm, or retained death foetus. The severity of the coagulopathy will vary from mild to severe, reflecting the imbalance of the haemostatic system.

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References

  1. McKay DG (1964) Disseminated intravascular coagulation. An intermediary mechanism of disease. Hoeber, New York, pp 715–728

    Google Scholar 

  2. Rangel Frausto MS, Pittet D, Costigan M et al (1995) The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 273:117–123

    Article  Google Scholar 

  3. Gullo A (2001) Disseminated intravascular coagulation (DIC) in the critical illness. Minerva Anestesiol 67:831–838

    PubMed  CAS  Google Scholar 

  4. Levi M, Cate H ten (1999) Disseminated intravascular coagulation. N Engl J Med 341:586–592

    Article  PubMed  CAS  Google Scholar 

  5. Cate H ten (1999) Clinical manifestations and diagnosis of DIC. Sepsis 3:147–151

    Article  Google Scholar 

  6. Vircocw R (1856) Phlogosy and thrombose in gefassystem. In: Vircow (ed) Gesammelte Abhhandlungen zur Wissenschaflichen Medicin. Von Meidinger Sohn, Frankfurt, pp 458–636

    Google Scholar 

  7. Muller-Berghaus G, Cate H ten, Levi M (1998) Disseminated intravascular coagulation. In: Cardiovascular thrombosis: thrombocardiology and thromboneurology, 2nd edn Verstraete M, Fuster V, Topol EJ (eds) Lippincott-Raven Publishers, Philadelphia, pp 781–798

    Google Scholar 

  8. Cate H ten (2000) Pathophysiology of disseminated intravascular coagulation in sepsis. Crit Care Med 28 [Suppl]:S9-S11

    Article  PubMed  Google Scholar 

  9. Dahlback B (2000) Blood coagulation. Lancet 355:1627–1632

    Article  PubMed  CAS  Google Scholar 

  10. McKenna R (2001) Abnormal coagulation in the postoperative period contributing to excessive bleeding. Med Clin North Am 85:1277–1310

    Article  PubMed  CAS  Google Scholar 

  11. Tura S (1997) Lezioni di ematologia. Ed. Esculapio 459–476

    Google Scholar 

  12. Fisher CJ, Dhainaut J-FA, Opal SM et al (1994) Recombinant human interleukin 1 receptor antagonist in the treatment of patients with sepsis syndrome. Results from a randomised, double bind, placebo controlled trial. JAMA 271:1836–1843

    Article  PubMed  Google Scholar 

  13. Ziegler EJ, Fisher CJ, Sprung CL et al (1991) Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin. A randomized, double bind, placebo controlled trial. N Engl J Med 324:429–436

    Article  PubMed  CAS  Google Scholar 

  14. Levi M, De Jonge E, Poll T van der, et al (1999) Disseminated intravascular coagulation. Thromb Haemost 82:695–705

    PubMed  CAS  Google Scholar 

  15. Rangel Frausto MS, Pittet D, Costigan M et al (1995) The natural history of the systemic inflammatory response syndrome (SIRS). Aprospective study. JAMA 273:117–123

    Article  Google Scholar 

  16. Wenzel RP, Pinsky MR, Ulevitch RJ, et al (1996) Current understanding of sepsis. Clin Infect Dis 22:407–1413

    Article  PubMed  CAS  Google Scholar 

  17. Levi M, Poll T van der, Cate H ten et al (1997) The cytokine mediated imbalance between coagulant and anticoagulant mechanisms in sepsis and endotoxaemia. Eur J Clin Invest 27:3–9

    Article  PubMed  CAS  Google Scholar 

  18. Poll T van der, Jonge E de, Levi M et al (2001) Regulatory role of cytokines in DIC. Semin Thromb Hemost 27:639–651

    Article  PubMed  Google Scholar 

  19. Poll T van der, Levi M, Deventer SJH van et al (1994) Differential effects of anti-TNF monoclonal antibodies on systemic inflammatory responses in experimental endotoxemia in chimpanzees. Blood 83:446–451

    PubMed  Google Scholar 

  20. Poll T van der, Coyle SM, Levi M et al (1997) Effect of a recombmant dimeric mmor necrosis factor receptor on inflammatory responses to intravenous endotoxin in normal humans. Blood 89:3727–3734

    PubMed  Google Scholar 

  21. Cate H ten, Shoenmakers SH, Franco R et al (2001) Microvascular coagulopathy and disseminated intravascular coagulation. Crit Care Med 29:S95-S98

    Article  PubMed  Google Scholar 

  22. Bick RL (1996) Disseminated intravascular coagulation: objective clinical and laboratory diagnosis, treatment, and assessment of therapeutic response. Semin Thromb Hemost 22:69–88

    Article  PubMed  CAS  Google Scholar 

  23. Gando S, Kameue T, Nanzaki S et al (1996) Disseminated intravascular coagulation is a frequent complication of systemic inflammatory response syndrome. Thromb Haemost 75:224–228

    PubMed  CAS  Google Scholar 

  24. Kobayashi N, Maekawa T, Takada M et al (1983) Criteria for diagnosis of DIC based on analysis of clinical and laboratory findings in 345 DIC patients collected by the Research Committee on DIC in Japan. Bibl Haematol 49:265–275

    PubMed  Google Scholar 

  25. Williams E (1989) Plasma a-2-antiplasmin activity: role in the evaluation and management of fibrinolytic states and other bleeding disorders. Arch Intern Med 149:1769–1772

    Article  PubMed  CAS  Google Scholar 

  26. Colman R (1972) Formation of human plasma kinin. N Engl J Med 291: 509–515

    Article  Google Scholar 

  27. Baglin T (1996) Disseminated intravascular coagulation: diagnosis and treatment. BMJ 312:683–687

    Article  PubMed  CAS  Google Scholar 

  28. Schetz MRC (1998) Coagulation disorders in acute renal failure. Kidney Int 53:S96–S101

    Google Scholar 

  29. Siegal T, Seligsohn U, Aghai E, Modan M (1978) Clinical and laboratory aspects of disseminated intravascular coagulation: a study of 118 cases. Thromb Haemost 39:122–134

    PubMed  CAS  Google Scholar 

  30. Toh CH (2001) Laboratory testing in disseminated intravascular coagulation. Semin Thromb Hemost 27:653–656

    Article  PubMed  CAS  Google Scholar 

  31. Colman R, Robboy S, Minna J (1972) Disseminated intravascular coagulation (DIC): an approach. Am J Med 52:679–687

    Article  PubMed  CAS  Google Scholar 

  32. Spero J, Lewis J, Hasiba U (1980) Disseminated intravascular coagulation. Findings in 346 patients. Thromb Haemosth 43:28–33

    CAS  Google Scholar 

  33. Bick RL (1998) Disseminated intravascular coagulation: pathophysiological mechanisms and manifestations. Semin Thromb Hemost 24:825–831

    Article  Google Scholar 

  34. Fijnvandraat K, Derkx B, Peters M et al (1995) Coagulation activation and tissue necrosis in meningococcal septic shock: severely reduced protein C levels predict a high mortality. Thromb Haemost 73:15–20

    PubMed  CAS  Google Scholar 

  35. Carr J, McKinney M, McDonagh J (1989) Diagnosis of disseminated intravascular coagulation. Role of D-dimer. Am J Clin Pathol 91:280–287

    PubMed  CAS  Google Scholar 

  36. Raimondi P, Bongard O, Moerloose P de et al (1993) D-dimer plasma concentration in various clinical conditions. Thromb Res 69:125–130

    Article  PubMed  CAS  Google Scholar 

  37. Okugawa Y, Wada H, Nöda T et al (2000) Increased plasma levels of tissue factor pathway inhibitor-activated factor X complex in patients with disseminated intravascular coagulation. Am J Hematol 65:210–1214

    Article  PubMed  CAS  Google Scholar 

  38. Gando S, Nakanishi Y, Tedo I (1995) Cytokines and plasminogen activator inhibitor-1 in posttrauma DIC: relationship to multiple organ dysfunction syndrome. Crit Care Med 23:1835–1842

    Article  PubMed  CAS  Google Scholar 

  39. Fourrier F, Chopin C, Goudemand J et al (1992) Septic shock, multiple organ failure and disseminated intravascular coagulation. Compared patterns of AT III, protein C and protein S deficiencies. Chest 101:816–823

    Article  PubMed  CAS  Google Scholar 

  40. Mesters RM, Mannucci PM, Coppola R et al (1996) Factor Vila and antithrombin III activity during severe sepsis and septic shock in neutropenic patients. Blood 88:881–886

    PubMed  CAS  Google Scholar 

  41. Opal S (2001) Chnical impact of novel anticoagulation strategies in sepsis. Curr Opin Crit Care 7:347–353

    Article  PubMed  CAS  Google Scholar 

  42. Levi M, De Jonge E (2000) Current management of disseminated intravascular coagulation. Hosp Pract 15:59–66

    Article  Google Scholar 

  43. Helhnan J, Warren HS (1999) Anti-endotoxin strategies. Infect Dis Clin N Am 13:371–382

    Article  Google Scholar 

  44. Vincent JL, Bakker J, Marecaux G et al (1992) Administration of anti-TNF antibody improves left ventricular function in septic shock patients. Chest 101:810–815

    Article  PubMed  CAS  Google Scholar 

  45. Salat C, Boekstegers P, Holler E et al (1996) Hemostatic parameters in sepsis patients treated with anti-TNFa monoclonal antibodies. Shock 6:233–237

    Article  PubMed  CAS  Google Scholar 

  46. Abraham E, Wunderink R, Silverman H et al (1995) Efficacy and safety of monoclonal antibody to human tumor necrosis factor a in patients with sepsis syndrome. A randomized, controlled, double-blind, multicenter clinical trial. JAMA 273:934–941

    Article  PubMed  CAS  Google Scholar 

  47. Dinarello CA (1997) Pro-inflammatory and anti-inflammatory cytokines as mediators in the pathogenesis of septic shock. Chest 112:321S–329S

    Article  PubMed  CAS  Google Scholar 

  48. Dickneite G, Leithauser B (1999) Influence of antithrombin III on coagulation and inflammation in porcine septic shock. Arterioscler Thromb Vase Biol 19:1566–1572

    Article  CAS  Google Scholar 

  49. Uchiba M, Okajiama K, Murakami K (1998) Effects of various doses of antithrombin III on endotoxin-induced endothelial cell injury and coagulation abnormalities in rats. Thromb Res 89:233–241

    Article  PubMed  CAS  Google Scholar 

  50. Nielsen JD (1998) The effect of antithrombin III on the systemic response in disseminated intravascular coagulation. Blood Coag Fibrinol 9[Suppl 3]:S11-S15

    Google Scholar 

  51. Okajiama R, Uchiba M (1998) The anti-inflammatory properties of antithrombin III: new therapeutic implications. Semin Thromb Hemost 24:27–32

    Article  Google Scholar 

  52. Hoffmann JN, Vollmar B, Inthom D et al (2000) Antithrombin reduces leukocyte adhesion during chronic endotoxemia by modulation of the cyclooxygenase pathway. Am J Physiol Cell 279:C98-C107

    CAS  Google Scholar 

  53. Fourrier F, Chopin C, Huart JJ et al (1993) Double, blind, placebo-controlled trial of antithrombin III concentrates in septic shock with disseminated intravascular coagulation. Chest 104:882–888

    Article  PubMed  CAS  Google Scholar 

  54. Inthorn D, Hoffmann JN, Hartl WH et al (1997) Antithrombin III supplementation in severe sepsis: beneficial effects on organ dysfunction. Shock 8:328–334

    Article  PubMed  CAS  Google Scholar 

  55. Baudo F, Caimi TM, deCataldo F et al (1998) Antithrombin III replacement therapy in patients with sepsis and/or postsurgical complication: a controlled double-blind, randomized, multicenter study. Intensive Care Med 24:336–342

    Article  PubMed  CAS  Google Scholar 

  56. Eisele B, Lamy M, Thijs LG et al (1998) AT HI in patients with severe sepsis. A randomized, placebo-controlled, double-blind trial plus a meta-analysis on all randomized, placebo-controlled, double-blind trials with antithrombin III in severe sepsis. Intensive Care Med 24:663–672

    Article  PubMed  CAS  Google Scholar 

  57. Knaub S, Keinecke HO, Juers M, et al (2001) High-dose AT III in patients with severe sepsis (abstract). Abstracts of the XVIII Congress of the International Society on Thrombosis and Haemostasis, Paris-France, p 523

    Google Scholar 

  58. Taylor FB, Chang A, Esmon CT et al (1987) Protein C prevents the coagulopathic and lethal effects of E. coli infusion in the baboon. J Clin Invest 79:918–925

    Article  PubMed  CAS  Google Scholar 

  59. Smith OP, White B, Vaughan D et al (1997) Use of protein C concentrate, heparin, and haemodiafiltration in meningococcus-induced purpura fulminans. Lancet 350:1590–1593

    Article  PubMed  CAS  Google Scholar 

  60. Van Deventer SJ, Pajkrt D (2001) Activated protein C, coagulation, inflammation, and treatment of severe sepsis. Ned Tijdschr Geneeskd 145:613–616

    PubMed  Google Scholar 

  61. Faust SN, Levin M, Harrison OB et al (2001) Dysfunction of endothehal protein C activation in severe meningococcal sepsis. N Engl J Med 345:408–416

    Article  PubMed  CAS  Google Scholar 

  62. Bernard GR, Vincent JL, Laterre PF et al (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699–709

    Article  PubMed  CAS  Google Scholar 

  63. Bernard GR, Vincent JL, Laterre PF et al (2002) Best evidence in anesthetic practice. Prevention: recombinant human activated protein C reduces mortality in severe sepsis. Can J Anesth 49:207–209

    Article  Google Scholar 

  64. Osterud B, Bjorklid E (2001) The tissue factor pathway in disseminated intravascular coagulation. Semin Thromb Hemost 27:605–617

    Article  PubMed  CAS  Google Scholar 

  65. Sandset PM, Roise O, Aasen AO et al (1989) Extrinsic pathway inhibitor in postoperative/posttraumatic septicemia: increased levels in fatal cases. Haemostasis 19:189–195

    PubMed  CAS  Google Scholar 

  66. De Jonge E, Dekkers PE, Creasey AA et al (2000) TFPI dose-dependently inhibits coagulation activation without influencing the fibrinolytic and cytokine response during human endotoxemia. Blood 95:1124–1129

    PubMed  Google Scholar 

  67. Camerota AJ, Creasey AA, Patla V et al (1998) Delayed treatment with recombinant human tissue factor pathway inhibitor improves survival in rabbits with gram-negative peritonitis. J Infect Dis 177:668–676

    Article  PubMed  CAS  Google Scholar 

  68. Creasey AA, Chang ACK, Feigen L et al (1993) TFPI reduces mortality from E coli septic shock. J Clin Invest 91:2850–2860

    Article  PubMed  CAS  Google Scholar 

  69. Feinstein DI (1982) Diagnosis and management of DIC: The role of heparin therapy. Blood 60:284–287

    PubMed  CAS  Google Scholar 

  70. Levi M (2001) Pathogenesis and treatment of disseminated intravascular coagulation in the septic patient. J Crit Care 16:167–177

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. M. L. Chierego
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  2. A. Gullo
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Editors and Affiliations

  1. Department of Perioperative Medicine, Intensive Care and Emergency, Trieste University School of Medicine, Trieste, Italy

    Antonino Gullo M.D. (Head) (Head)

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Chierego, M.L., Gullo, A. (2003). Consumption coagulopathy. In: Gullo, A. (eds) Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-2215-7_43

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  • DOI: https://doi.org/10.1007/978-88-470-2215-7_43

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0194-7

  • Online ISBN: 978-88-470-2215-7

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