Diversity of disseminated intravascular coagulation and selection of appropriate treatments

Asakura, Hitoshi

doi:10.1007/s12185-020-03030-5

Cited by 16 publications

(20 citation statements)

References 17 publications

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“…Second, coagulation/fibrinolysis markers, such as TAT and PIC, were not followed up during hospitalization. COVID-19 is considered to present with suppressed-fibrinolytic-type DIC in the early and middle stages and suddenly turn into enhanced-fibrinolytic-type DIC [ 19 ]. We focused on normal D-dimer; therefore, a coagulation/fibrinolysis marker that occurs in the early stages of SARS-CoV-2 infection, it is impossible to argue at what point in time the suppressed-fibrinolytic-type DIC will transfer to the fibrinolytic-type DIC.…”

Section: Discussionmentioning

confidence: 99%

Elevated TAT in COVID-19 Patients with Normal D-Dimer as a Predictor of Severe Respiratory Failure: A Retrospective Analysis of 797 Patients

Takeshita

Terada

Hirasawa

et al. 2021

JCM

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Although previous studies have revealed that elevated D-dimer in the early stage of coronavirus 2019 (COVID-19) indicates pulmonary intravascular coagulation, the state of coagulation/fibrinolysis disorder with normal D-dimer is unknown. The study aimed to investigate how coagulation/fibrinolysis markers affect severe respiratory failure in the early stage of COVID-19. Among 1043 patients with COVID-19, 797 patients were included in our single-center retrospective study. These 797 patients were divided into two groups, the normal D-dimer and elevated D-dimer groups and analyzed for each group. A logistic regression model was fitted for age, sex, body mass index (BMI) ≥ 30 kg/m2, fibrinogen ≥ 617 mg/dL, thrombin-antithrombin complex (TAT) ≥ 4.0 ng/mL, and plasmin-alpha2-plasmin inhibitor-complex (PIC) > 0.8 µg/mL. A multivariate analysis of the normal D-dimer group demonstrated that being male and TAT ≥ 4.0 ng/mL significantly affected severe respiratory failure. In a multivariate analysis of the elevated D-dimer group, BMI ≥ 30 kg/m2 and fibrinogen ≥ 617 mg/dL significantly affected severe respiratory failure. The elevated PIC did not affect severe respiratory failure in any group. Our study demonstrated that hypercoagulation due to SARS-CoV-2 infection may occur even during a normal D-dimer level, causing severe respiratory failure in COVID-19.

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Section: Discussionmentioning

confidence: 99%

Elevated TAT in COVID-19 Patients with Normal D-Dimer as a Predictor of Severe Respiratory Failure: A Retrospective Analysis of 797 Patients

Takeshita

Terada

Hirasawa

et al. 2021

JCM

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“…Disseminated intravascular coagulation (DIC) represents a serious condition in which activation of coagulation and promotion of fibrinolysis in the circulating blood occur simultaneously (1,2). Organ failure and bleeding are characteristic symptoms of DIC (3,4).…”

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confidence: 99%

Effect of NOS Inhibitors and Anticoagulants on Nitric Oxide Production in a Tissue-factor Induced Rat DIC Model

Suga

Takahashi

Shimada

et al. 2021

In Vivo

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Background/Aim: We examined the mechanism of nitric oxide (NO) production in a tissue-factor (TF)-induced disseminated intravascular coagulation (DIC) model in rats, using inducible nitric oxide synthase (iNOS) inhibitor (L-NIL), endothelial nitric oxide synthase (eNOS) inhibitor (L-NAME), Factor Xa inhibitor (DX-9065a), and thrombin inhibitor argatroban. Materials and Methods: Experimental DIC was induced by sustained infusion of 3.75 U/kg TF for 4 h via the tail vein. We then investigated the effect of these four agents on TF-induced DIC. Results: Administration of L-NIL or L-NAME during induction of TF-induced DIC did not affect hemostatic markers, whereas elevated plasma levels of NO metabolites (NOX) were significantly suppressed by co-administration of L-NAME. A significant increase in eNOS-mRNA expression was observed in the TFinduced DIC model. Argatroban almost completely suppressed eNOS-mRNA expression. Conclusion: eNOS plays an important role in the NO production in the TFinduced DIC, and thrombin is a key stimulant of eNOS-mRNA expression in this model.

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“…1 We should not overlook cases of so-called "enhanced-fibrinolytic-type disseminated intravascular coagulation (DIC)" showing decreased fibrinogen levels with markedly elevated FDP levels in their plasma. 2,3 In such critical condition, divergence would be observed between FDP and D-dimer because the D-dimer level often remains mild to moderate. 2,3 To integrate and analyze such coagulation data, we recommend that they should be plotted on a coordinate plane with fibrinogen, FDP (or D-dimer) as both axes.…”

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confidence: 99%

“…2,3 In such critical condition, divergence would be observed between FDP and D-dimer because the D-dimer level often remains mild to moderate. 2,3 To integrate and analyze such coagulation data, we recommend that they should be plotted on a coordinate plane with fibrinogen, FDP (or D-dimer) as both axes. This is expected to reveal any meaningful patterns in the scattered state of individual cases with circuit coagulation and pressure rise.Precise conditions in such coagulopathies that could not be recognized by FDP (D-dimer) alone or fibrinogen…”

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confidence: 99%

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Possibility of PMX‐DHP therapy as a principal strategy against cytokine storm in COVID‐19: Insights from reconstructed coagulation data

Ogawa

Kakuchi

Asakura

2021

J of Clinical Apheresis

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Diversity of disseminated intravascular coagulation and selection of appropriate treatments

Cited by 16 publications

References 17 publications

Elevated TAT in COVID-19 Patients with Normal D-Dimer as a Predictor of Severe Respiratory Failure: A Retrospective Analysis of 797 Patients

Elevated TAT in COVID-19 Patients with Normal D-Dimer as a Predictor of Severe Respiratory Failure: A Retrospective Analysis of 797 Patients

Effect of NOS Inhibitors and Anticoagulants on Nitric Oxide Production in a Tissue-factor Induced Rat DIC Model

Possibility of PMX‐DHP therapy as a principal strategy against cytokine storm in COVID‐19: Insights from reconstructed coagulation data

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