Prediction of survival in patients suspected of disseminated intravascular coagulation

Hjörleifsson, Einar; Sigurðsson, Martin I; Gudmundsdottir, Brynja R.; Sigurðsson, Gísli H.; Önundarson, Páll T.

doi:10.1111/aas.12537

Cited by 12 publications

(8 citation statements)

References 29 publications

(31 reference statements)

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“…It is possible that these differences might have contributed to the higher proportion of patients with DIC according to the JAAM score compared to the ISTH-score. A high DIC score has been shown to be associated with a high incidence of massive bleeding and mortality [ 2 , 25 , 26 ], and, as shown in our study, to be associated with a longer stay in the ICU [ 25 ]. We also found higher mortality of patients with DIC and higher DIC scores in non-survivors.…”

Section: Discussionsupporting

confidence: 70%

“…We also found higher mortality of patients with DIC and higher DIC scores in non-survivors. It has recently been suggested that the use of the fixed ISTH score of ≥5 misses many patients with life-threatening DIC [ 25 ]. To assign patients to DIC and overt DIC a score of ≥ 4 for JAAM and ≥5 for ISTH, respectively, at any time point during the 10 day period was used in our study and a similar strategy was used in a recent study [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

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Assessment of Haemostasis in Disseminated Intravascular Coagulation by Use of Point-of-Care Assays and Routine Coagulation Tests, in Critically Ill Patients; A Prospective Observational Study

et al. 2016

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BackgroundDisseminated intravascular coagulopathy (DIC) relates to the consumption of coagulation factors and platelets with bleeding and micro thrombosis events.AimThe aim of this study was to compare haemostasis parameters in critically ill patients with DIC versus patients without DIC, and in survivors versus non-survivors over time. Correlations between the DIC-score, the degree of organ failure and the haemostasis were assessed.MethodPatients admitted to the intensive care unit with a condition known to be associated with DIC and with an expected length of stay of >3 days were included. Routine laboratory tests, prothrombin time, activated partial thromboplastin time, platelet count, fibrinogen concentration and D-dimer were measured. Coagulation and platelet function were assessed with two point-of-care devices; Multiplate and ROTEM. DIC scores were calculated according to the International Society on Thrombosis and Haemostasis and Japanese Association for Acute Medicine.ResultsBlood was sampled on days 0–1, 2–3 and 4–10 from 136 patients with mixed diagnoses during 290 sampling events. The point-of-care assays indicated a hypocoagulative response (decreased platelet aggregation and reduced clot strength) in patients with DIC and, over time, in non-survivors compared to survivors. Patients with DIC as well as non-survivors had decreased fibrinolysis as shown by ROTEM. DIC scores were higher in non-survivors than in survivors.ConclusionsPatients with DIC displayed signs of a hypocoagulative response and impaired fibrinolysis, which was also evident over time in non-survivors. Patients with DIC had a higher mortality rate than non-DIC patients, and DIC scores were higher in non-survivors than in survivors.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Assessment of Haemostasis in Disseminated Intravascular Coagulation by Use of Point-of-Care Assays and Routine Coagulation Tests, in Critically Ill Patients; A Prospective Observational Study

et al. 2016

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“…In our dataset antiplasmin (another natural antifibrinolytic substance) was not measured due to analytical constraints. There are no data about the time course of antiplasmin activity in major trauma; however, it has to be synthesised within cells (like PAI-1), and in other conditions, it rises over days rather than hours 21. This study was carried out in a small sample and there were no patients with penetrating trauma (reflecting the normal UK major trauma population in 2004) so our results can only be definitely applied to blunt trauma.…”

Section: Discussionmentioning

confidence: 95%

Biological mechanisms and individual variation in fibrinolysis after major trauma

Coats

Morsy

2020

Emerg Med J

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ObjectiveTo understand more about the individual variation in the time course of fibrinolysis following major injury and to assess the potential for stratification of trauma patients for tranexamic acid (TXA) therapy.MethodsA historical dataset (from 2004) was used, consisting of samples from 52 injured patients attended by a medical prehospital system. Blood samples were taken at the incident scene, on arrival in the emergency department, 2.5 hours after hospital arrival and 5 hours after hospital arrival. From the study database, we extracted values for tissue-type plasminogen activator (tPA; an activator of fibrinolysis), one of the plasminogen activator inhibitors (PAI-1; as a natural inhibitor of fibrinolysis) and D-dimer (as a marker of the extent of fibrinolysis).ResultsThe changes over time in median tPA and PAI-1 were mirror images, with initial high tPA levels which then rapidly decreased and low initial PAI-1 levels which slowly increased. There were high levels of fibrinolytic activity (D-dimer) throughout. This pattern was present in patients across a broad range of injury severities.ConclusionsAfter major trauma, there seems to be an early ‘antifibrinolytic gap’ with the natural antifibrinolytic system lagging several hours behind the natural profibrinolytics. An early dose of exogenous antifibrinolytic (TXA) might have its effect by filling this gap. The finding that tPA and subsequent clot breakdown (illustrated by D-dimer formation) are raised in a broad range of patients, with little correlation between the initial fibrinolytic response and markers of injury severity, may be the reason that TXA is effective across a broad range of injured patients.

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“…62 In a large cohort of patients with sepsis and suspected DIC, reduced AT and PC levels were predictive of mortality, regardless of whether the patient met the ISTH criteria for overt DIC. 63 Other markers of various aspects of coagulation and fibrinolysis have also been studied, with promising results, including TAT, SF, TFPI, PAI-1, von Willebrand factor, and Adamts-13. 62 D-dimers, a component of the ISTH DIC scoring algorithm, and fibrin monomer have been proposed as individual predictive markers of DIC.…”

Section: Biomarkers For the Diagnosis And Follow-up Of Dicmentioning

confidence: 99%

Disseminated Intravascular Coagulation: An Update on Pathogenesis, Diagnosis, and Therapeutic Strategies

Papageorgiou

Jourdi

Adjambri

et al. 2018

Clin Appl Thromb Hemost

150

121

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Disseminated intravascular coagulation (DIC) is an acquired clinicobiological syndrome characterized by widespread activation of coagulation leading to fibrin deposition in the vasculature, organ dysfunction, consumption of clotting factors and platelets, and life-threatening hemorrhage. Disseminated intravascular coagulation is provoked by several underlying disorders (sepsis, cancer, trauma, and pregnancy complicated with eclampsia or other calamities). Treatment of the underlying disease and elimination of the trigger mechanism are the cornerstone therapeutic approaches. Therapeutic strategies specific for DIC aim to control activation of blood coagulation and bleeding risk. The clinical trials using DIC as entry criterion are limited. Large randomized, phase III clinical trials have investigated the efficacy of antithrombin (AT), activated protein C (APC), tissue factor pathway inhibitor (TFPI), and thrombomodulin (TM) in patients with sepsis, but the diagnosis of DIC was not part of the inclusion criteria. Treatment with APC reduced 28-day mortality of patients with severe sepsis, including patients retrospectively assigned to a subgroup with sepsis-associated DIC. Treatment with APC did not have any positive effects in other patient groups. The APC treatment increased the bleeding risk in patients with sepsis, which led to the withdrawal of this drug from the market. Treatment with AT failed to reduce 28-day mortality in patients with severe sepsis, but a retrospective subgroup analysis suggested possible efficacy in patients with DIC. Clinical studies with recombinant TFPI or TM have been carried out showing promising results. The efficacy and safety of other anticoagulants (ie, unfractionated heparin, low-molecular-weight heparin) or transfusion of platelet concentrates or clotting factor concentrates have not been objectively assessed.

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Prediction of survival in patients suspected of disseminated intravascular coagulation

Cited by 12 publications

References 29 publications

Assessment of Haemostasis in Disseminated Intravascular Coagulation by Use of Point-of-Care Assays and Routine Coagulation Tests, in Critically Ill Patients; A Prospective Observational Study

Assessment of Haemostasis in Disseminated Intravascular Coagulation by Use of Point-of-Care Assays and Routine Coagulation Tests, in Critically Ill Patients; A Prospective Observational Study

Biological mechanisms and individual variation in fibrinolysis after major trauma

Disseminated Intravascular Coagulation: An Update on Pathogenesis, Diagnosis, and Therapeutic Strategies

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