Viral hemorrhagic fevers due to endotheliopathy-associated disseminated intravascular microthrombosis and hepatic coagulopathy: pathogenesis based on “two activation theory of the endothelium”

Chang, Jae C.

doi:10.15761/cmid.1000124

Cited by 9 publications

(16 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is also associated with thrombocytopenia (i.e., TCIP) and disseminated intravascular microthrombosis (DIT) [28,29]. Other clinical syndromes associated with critical illnesses include SIRS [13,14], ARDS [19,22], MODS [4,6,11,12,14], "DIC" [30][31][32], thrombotic thrombocytopenic purpura (TTP)-like syndrome [33][34][35][36][37][38][39], hepatic coagulopathy, and others [36,40].…”

Section: Endothelium and Critical Illnessesmentioning

confidence: 99%

“…Increasing thrombocytopenia was associated with higher mortality and longer length of hospital stay, and the increase of the platelet count was an early sign of clinical improvement [2][3][4][6][7][8][9][10] Contrary to this concept, microthrombogenesis plays a key role in the pathogenesis of TTP and TTP-like syndrome. In endotheliopathy, the platelet is activated and excessive amounts of ULVWF are released from ECs [24][25][26][27]40]. The result is the formation of microthrombi made of platelet-ULVWF complexes, which also lead to vascular microthrombosis [26,27,34,36,40].…”

Section: Tcip In the Critical Care Settingmentioning

confidence: 99%

“…In endotheliopathy, the platelet is activated and excessive amounts of ULVWF are released from ECs [24][25][26][27]40]. The result is the formation of microthrombi made of platelet-ULVWF complexes, which also lead to vascular microthrombosis [26,27,34,36,40].…”

Section: Tcip In the Critical Care Settingmentioning

confidence: 99%

“…To annotate inflammation and circulatory disorder in the critical illness, a novel hypothesis of "two-activation theory of the endothelium" is proposed [36,40].…”

Section: Tcip In the Critical Care Settingmentioning

confidence: 99%

“…DIT is the underlying pathology provoking vascular microthrombotic disease (VMTD) [36,40], which triggers hypoxic multi-organ dysfunction and thrombotic microangiopathy (TMA). Three kinds of disseminated VMTD are known to exist: 1) antibodyassociated VMTD (i.e., acquired TTP), 2) gene mutation-associated VMTD (i.e., hereditary TTP), and 3) endotheliopathy-associated VMTD (TTP-like syndrome).…”

Section: Endotheliopathy-associated Vascular Microthrombotic Diseasementioning

confidence: 99%

See 4 more Smart Citations

Thrombocytopenia in critically ill patients due to vascular microthrombotic disease: pathogenesis based on “two activation theory of the endothelium”

Chang¹

2017

Vascul Dis Ther

Self Cite

View full text Add to dashboard Cite

Section: Endothelium and Critical Illnessesmentioning

confidence: 99%

Section: Tcip In the Critical Care Settingmentioning

confidence: 99%

Section: Tcip In the Critical Care Settingmentioning

confidence: 99%

“…To annotate inflammation and circulatory disorder in the critical illness, a novel hypothesis of "two-activation theory of the endothelium" is proposed [36,40].…”

Section: Tcip In the Critical Care Settingmentioning

confidence: 99%

Section: Endotheliopathy-associated Vascular Microthrombotic Diseasementioning

confidence: 99%

See 3 more Smart Citations

Thrombocytopenia in critically ill patients due to vascular microthrombotic disease: pathogenesis based on “two activation theory of the endothelium”

Chang¹

2017

Vascul Dis Ther

Self Cite

View full text Add to dashboard Cite

Hemostasis based on a novel ‘two-path unifying theory’ and classification of hemostatic disorders

Chang

2018

Blood Coagulation &Amp; Fibrinolysis

134

View full text Add to dashboard Cite

: Hemostasis is the most important protective mechanism for human survival following harmful vascular damage caused by internal disease or external injury. Physiological mechanism of hemostasis is partially understood. Hemostasis can be initiated by either intravascular injury or external bodily injury involving two different levels of damage [i.e., limited to the endothelium or combined with extravascular tissue (EVT)]. In intravascular injury, traumatic damage limited to local endothelium typically is of no consequence, but disease-induced endothelial damage associated with systemic endothelial injury seen in sepsis and other critical illnesses could cause generalized 'endotheliopathy'. It triggers no bleeding but promotes serious endothelial molecular response. If intravascular local trauma extends beyond the endothelium and into EVT, it causes intravascular 'bleeding' and initiate 'clotting' via normal hemostasis. In external bodily injury, local traumatic damage always extends to the endothelium and EVT, and triggers 'bleeding' and 'clotting'. Systemic endotheliopathy activates only unusually large von Willebrand factor multimers (ULVWF) path and mediates 'microthrombogenesis', producing 'microthrombi' strings. This partial activation of hemostasis with ULVWF path leads to vascular microthrombotic disease. But localized traumatic injury extending to the endothelium and EVT activates both ULVWF and tissue factor paths. Combined activation of ULVWF and tissue factor paths provides normal hemostasis in external bodily injury, but causes 'macrothrombus' formation in intravascular injury. This 'two-path unifying theory' concept succinctly elucidates simplified nature of hemostasis in intravascular and external bodily injuries. It also clarifies different pathogenesis of every hemorrhagic disease and thrombotic disorder related to internal vascular disease and external vascular injury.

show abstract

Thrombogenesis and thrombotic disorders based on ‘two-path unifying theory of hemostasis’

Chang

2018

Blood Coagulation &Amp; Fibrinolysis

129

View full text Add to dashboard Cite

Viral hemorrhagic fevers due to endotheliopathy-associated disseminated intravascular microthrombosis and hepatic coagulopathy: pathogenesis based on “two activation theory of the endothelium”

Cited by 9 publications

References 35 publications

Thrombocytopenia in critically ill patients due to vascular microthrombotic disease: pathogenesis based on “two activation theory of the endothelium”

Thrombocytopenia in critically ill patients due to vascular microthrombotic disease: pathogenesis based on “two activation theory of the endothelium”

Hemostasis based on a novel ‘two-path unifying theory’ and classification of hemostatic disorders

Thrombogenesis and thrombotic disorders based on ‘two-path unifying theory of hemostasis’

Contact Info

Product

Resources

About