Classifying types of disseminated intravascular coagulation: clinical and animal models

Abstract

Disseminated intravascular coagulation (DIC) has a common pathogenesis in terms of persistent widespread activation of coagulation in the presence of underlying disease, but the degree of fibrinolytic activation often differs by DIC type. DIC with suppressed fibrinolysis is a DIC type usually seen in sepsis. Coagulation activation is severe, but fibrinolytic activation is mild. DIC with enhanced fibrinolysis is a DIC type usually seen in acute promyelocytic leukemia (APL). Both coagulation activation and fibrinolytic activation are severe. DIC with balanced fibrinolysis is a DIC type usually seen in solid tumors, with an intermediate pathogenesis between the above two types. In animal DIC models, lipopolysaccharide (LPS)-induced models are similar to suppressed-fibrinolytic-type DIC, whereas tissue factor (TF)-induced models are similar to enhanced fibrinolytic/balanced fibrinolytic DIC. Appropriate diagnosis and treatment may also differ depending on the DIC type.

Role for Neutrophil Extracellular Traps (NETs) and Platelet Aggregation in Early Sepsis-induced Hepatic Dysfunction

“…It has been thought that organ dysfunction caused by sepsis arises because DIC leads to microclots that occur simultaneously and systemically (31). However, we must consider the influence of extravasated platelet aggregation wherein platelets adhere to the outside of blood vessels.…”

Fibrin/fibrinogen degradation products (FDP) at hospital admission predict neurological outcomes in out-of-hospital cardiac arrest patients

“…[19][20][21][22] Basal conditions during DIC occasionally cause a simultaneous increase in fibrin(ogen)olysis resulting from tissue-type plasminogen activator (t-PA), which is referred to as DIC with the fibrinolytic phenotype, as opposed to the thrombolytic phenotype. 23 Hyperfibrinolysis is reportedly common in OHCA patients and has been associated with markers of hypoperfusion in these patients. 24,25 If not improved, DIC with the fibrinolytic phenotype during the early stage of OHCA proceeds to the thrombotic phenotype at the later stage of OHCA.…”

“…20 Both types of DIC affect the patient outcomes. 19,23 Based on assessment of the mortality rate in OHCA patients one month after cardiac arrest, DIC with the fibrinolytic phenotype predicted the outcome. 26 However, neurological outcomes of OHCA patients were not assessed.…”

Severe coagulopathy and transient hypertension following a Rhabdophis subminiatus bite: a case report

“…As a result, end organ damage rarely occurs but severe bleeding manifestations are common. The diagnostic criteria for DIC with enhanced fi brinolysis includes an elevated thrombinantithrombin complex (≥20µg/L), a plasmin-α 2 complex ≥10µg/L, a fi brin degradation product (FDP) level ≥80µg/L, a fi brinogen level <100mg/dL, and an increased FDP/D-dimer ratio (5) . Other useful hemostatic tests include a 20-minute whole blood clotting test, a PT test, an aPTT test, and an INR test (6) .…”