Laboratory methods for detecting disseminated intravascular coagulation (DIC): new aspects

Abstract

The objective was to diagnose a hypercoagulative state or "pre-DIC" with new laboratory tests. APACHE II score was used as a measure of primary illness. Ventilator time was used as a reflexion of secondary complications. Twenty-three ICU patients were divided into two groups depending on time on the ventilator: Group 1 > 7 days and Group II < or = 7 days. If, after admittance patients deteriorated or complications occurred, new quantitative coagulation tests were done: soluble fibrin, prothrombin fragment 1 + 2, thrombin-antithrombin complex, D-dimer and elastase. We found a positive correlation between SF levels, the APACHE II score and the ventilator time. Diagnostic efficacy for SF was 87%, sensitivity 91%, specificity 83%, the predictive value of a positive result was 87% and the predictive value of a negative result 91%. The levels of the other new tests were also generally higher in the clinically worse group, although not significantly. Prothrombin complex, APTT, platelet count and AT III were pathologic to the same extent in both groups. The patients who developed most secondary complications, resulting in longer ventilator treatment (Group I), were also hypercoagulative. Soluble fibrin, in particular, seems to be valuable in the diagnosis of "pre-DIC" and possibly of predictive value for organ system complications.

Heparin Blunts Endotoxin-Induced Coagulation Activation

“…In contrast, using a chromogenic assay based on fibrin-mediated conversion of plasminogen to plasmin, 22 we found no increase in any study subject. Although this confirms our previous results with twice the dose of LPS, our findings are at variance with clinical trials 10,22 that reported increases in soluble fibrin with similar assays. Differences in sensitivity between chromogenic assays and EIA for soluble fibrin have been described previously, particularly at soluble fibrin levels Ͻ10 g/mL, 33,34 and are a likely explanation for the discrepancies between the functional assay and the TpP assay found in our trial (Figure 2).…”

“…First, we used a chromogenic assay that used the potential of fibrin to convert plasminogen to plasmin (Coatest, Chromogenix; normal range 25 to 75 arbitrary units). 10,22 Second, we used an enzyme immunoassay (EIA) for polymers of soluble fibrin, termed thrombus precursor protein (TpP; American Biogenetic Sciences; normal values Ͻ6 g/mL). The antibody of this assay does not cross-react with fibrinogen, desAAfibrin, or D-dimer.…”

“…6,7 Ongoing DIC causes changes in plasma levels of all coagulation factors: clinical studies reported decreased levels of FVIIa 8 and increased levels of soluble TF, 9 prothrombin fragment (F 1ϩ2 ), and soluble fibrin, resulting in increases of fibrin split products such as D-dimer. 10 In the clinical setting, inhibition of coagulation with low doses of unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) has been recommended by some authors, although no consensus exists on the clinical efficacy of either drug. 2 Heparin enhances inactivation of thrombin and factor Xa via antithrombin III but also increases plasma levels of endogenous TF pathway inhibitor (TFPI).…”

The prognostic value of global haemostatic tests in the intensive care unit setting

“…Median (first and third quartiles within parentheses). 3 Significant difference between the study and the control group (total and subgroups, respectively); P Ͻ 0.001.…”

“…The results of these tests are often abnormal in acquired coagulation disorders, which are commonly seen in patients admitted to intensive care units. There are also more sophisticated methods designed specifically for detecting alterations in the coagulation and fibrinolytic systems, including assays for soluble fibrin, thrombin-antithrombin complexes, prothrombin fragment 1 π 2, antithrombin, fibrin D-dimers, and protein C. These analyses can facilitate the diagnosis of DIC (1)(2)(3)(4), but, unfortunately, most of them are very expensive and are available only during office hours at a limited 1062 pronounced in patients with medical disorders, whereas the survival rate was slightly higher in surgery patients. Expressing the survival predicting ability of the screening tests as odds ratios for all patients (study and control groups together) indicated that prolonged APTT in particular foretold a lower survival rate at studied time-points after admission to the ICU.…”