Atih Treatment in Patients (Pts) Requiring Hemodinamyc (H) and Respiratory (R) Support (S)

Baudo, F.; D’Angelo, Armando; Caimi, Teresa Maria; Decataldo, Francesco; Ravizza, A.; Casella, Giampaolo; Carugo, Dario; Arlati, Sergio; Palareti, Gualtiero; Legnani, Cristina; Ridolfi-L,; Rossi, Robert M.; Crippa, L.; Guidici, Daniela; Gallioli, G; Wolfler, Andrea; Calori, GM

doi:10.1097/00024382-199703001-00663

Cited by 3 publications

(4 citation statements)

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“…However, values of TAT reaching 900 g/l were much higher than those observed in patients with other causes of DIC, in which the levels did not exceed 100 g/l (9, 10, 51, 52). Interestingly, it seems that AT is not consumed as it is in other types of DIC (12,51), even though large amounts of thrombin and TAT complex seem to be generated, particularly in patients with a more severe coagulopathy. Therefore, despite the presence of consumptive coagulopathy in L. obliqua envenomation, the initiation and maintenance mechanisms of this special form of DIC seems to be different from that observed in other clinical situations.…”

Section: Human Accidentsmentioning

confidence: 99%

Biochemical and biological properties of Lonomia obliqua bristle extract

Chudzinski-Tavassi¹,

Carrijo-Carvalho²

2006

J. Venom. Anim. Toxins incl. Trop. Dis

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Lonomia obliqua caterpillar is frequently seen in accidents with humans especially in the south of Brazil. Patients develop a hemorrhagic syndrome that can be treated with specific antilonomic serum. A consumptive coagulopathy was found to be the main cause of bleeding complications observed in patients after contact with L. obliqua. Studies revealed that L. obliqua caterpillar bristle extract (LOCBE) displays a procoagulant activity that leads to intravascular thrombin formation, resulting in a special form of disseminated intravascular coagulation (DIC). Fibrinolysis seems to be secondary to the fibrin production, since no direct fibrinolytic activity was found in LOCBE. Two procoagulant toxins, a factor X activator (Losac) and a prothrombin activator (Lopap), were isolated from LOCBE and characterized. Infusion of Lopap into experimental animals triggered a condition similar to that observed in human envenomation

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Section: Human Accidentsmentioning

confidence: 99%

Biochemical and biological properties of Lonomia obliqua bristle extract

Chudzinski-Tavassi¹,

Carrijo-Carvalho²

2006

J. Venom. Anim. Toxins incl. Trop. Dis

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“…A number of controlled clinical trials of antithrombin concentrates have been conducted with these patients. [73][74][75][76][77][78] Most of these trials concern patients with sepsis and/or septic shock. All trials show some beneficial effect in terms of improvement of a DIC score, shortening of the duration of DIC, or even improvement in organ function.…”

Section: Coagulation Inhibitor Concentratesmentioning

confidence: 99%

Disseminated Intravascular Coagulation

Levi

Jonge²,

Poll³

et al. 1999

Thromb Haemost

194

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IntroductionA quick literature search in the MEDLINE databases from 1966 to 1998 using the search term disseminated intravascular coagulation (DIC) and related key words yields an impressive 11,921 manuscripts. Most of the published literature concerns the pathophysiology of DIC, which in its main features is now well understood. Other aspects of DIC, however, particularly those related to the definition, the relevance of the syndrome, and clinical management, remain unclear. Taking an evidence-based approach to the appropriate diagnosis and treatment of patients with DIC is difficult, in view of the lack of sound clinical trials. This is probably due to the fact that DIC is a poorly-defined syndrome with a widely variable intensity, often complicating a diversity of severe disorders that are themselves related to extensive morbidity and mortality.1,2 This chapter briefly reviews the clinical setting, incidence, and relevance of DIC and current insights into the pathogenesis of DIC. It also discusses the available knowledge on the clinical management of patients with this syndrome.DIC is not a disease or a symptom but rather a syndrome, which is always secondary to an underlying disorder. The syndrome is characterized by a systemic activation of the blood coagulation system, which results in the generation and deposition of fibrin, leading to microvascular thrombi in various organs and contributing to the development of multiorgan failure. Consumption and subsequent exhaustion of coagulation proteins and platelets, due to the ongoing activation of the coagulation system, may induce severe bleeding complications, although microclot formation may occur in the absence of severe clotting factor depletion and bleeding.3 Derangement of the fibrinolytic system further contributes to intravascular clot formation (discussed later), but in some cases accelerated fibrinolysis (e.g., due to consumption of α2-antiplasmin) may cause severe bleeding. Hence, a patient with DIC can present with simultaneous thrombotic and bleeding problems, which obviously complicates treatment. Although there is no general consensus regarding the definition of DIC, the definition as put forward by Müller-Berghaus and colleagues in 1995 might be most appropriate: “Disseminated intravascular coagulation is an acquired syndrome characterized by the activation of intravascular coagulation up to intravascular fibrin formation. The process may be accompanied by secondary fibrinolysis or inhibited fibrinolysis.”4

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“…Sir: Sepsis may be associated with downregulation of monocyte HLA-DR expression and a reduced capacity in whole blood to produce tumor necrosis factor-a (TNFa) [1]. This phenomenon has been called ªimmunoparalysisº [2].…”

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confidence: 99%

“…This phenomenon has been called ªimmunoparalysisº [2]. Interferon gamma (IFNg) may restore HLA-DR expression on monocytes [4] and reestablish monocyte TNFa production in immunoparalysis [1].…”

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confidence: 99%