Disseminated Intravascular Coagulation (DIC) at an Early Phase of Trauma Continuously Proceeds to DIC at a Late Phase of Trauma

Murakami, Hiromoto; Gando, Satoshi; Hayakawa, Mineji; Sawamura, Atsushi; Shinoda, Masahiro; Kubota, Nobuhiko; Uegaki, Shinji; Jesmin, Subrina

doi:10.1177/1076029611426138

Cited by 13 publications

(11 citation statements)

References 14 publications

(28 reference statements)

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“…DIC at the early phase of trauma shows the fibrinolytic phenotype, which contributes to massive bleeding and patients’ prognoses . DIC at the late phase of trauma is a thrombotic phenotype that also affects patient prognosis but by the development of multiple organ dysfunction syndrome (MODS) . The synergistic activation of primary and secondary fibrin(ogen)olysis is the cause of DIC with the fibrinolytic phenotype , while both depression of the inhibitory system of coagulation and plasminogen activator inhibitor‐1 (PAI‐1)‐mediated inhibition of fibrinolysis cause DIC with the thrombotic phenotype .…”

Section: Basic Concepts Of Dic With the Fibrinolytic Phenotype And Comentioning

confidence: 99%

“…Hemostasis after trauma is a dynamic process that varies constantly. Serial measurements of global coagulation and fibrinolysis markers demonstrated that DIC during an early phase of trauma continuously progresses to DIC at a late phase of trauma . Almost all COT/ACOTS studies, however, use only single‐point sampling of blood on arrival at the emergency department, and lack a control cohort .…”

Section: Basic Principles Of Hemostasis and Wound Healing In Traumamentioning

confidence: 99%

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Differentiating disseminated intravascular coagulation (DIC) with the fibrinolytic phenotype from coagulopathy of trauma and acute coagulopathy of trauma-shock (COT/ACOTS)

Gando

Wada

Thachil

2013

Journal of Thrombosis and Haemostasis

122

137

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To cite this article: Gando S, Wada H, Thachil J. Differentiating disseminated intravascular coagulation (DIC) with the fibrinolytic phenotype from coagulopathy of trauma and acute coagulopathy of trauma-shock (COT/ACOTS). J Thromb Haemost 2013; 11: 826-35.Summary. Two concepts have been proposed for the hemostatic changes occurring early after trauma. Disseminated intravascular coagulation (DIC) with the fibrinolytic phenotype is characterized by activation of the coagulation pathways, insufficient anticoagulant mechanisms and increased fibrinolysis. Coagulopathy of trauma and acute coagulopathy of trauma-shock (COT/ACOTS) occurs as a result of increased activation of the thrombomodulin and protein C pathways, leading to the suppression of coagulation and activation of fibrinolysis. Despite the differences between these two conditions, independent consideration of COT/ACOTS from DIC with the fibrinolytic phenotype is probably incorrect. Robust diagnostic criteria based on its pathophysiology are required to establish COT/ACOTS as a new independent disease concept. In addition, the independency of its characteristics, laboratory data, time courses and prognosis from DIC should be confirmed. Confusion between two concepts may be based on studies of trauma lacking the following: (i) a clear distinction of the properties of blood between the inside and outside of vessels, (ii) a clear distinction between physiologic and pathologic hemostatic changes, (iii) attention to the time courses of the changes in hemostatic parameters, (iv) unification of the study population, and (v) recognition that massive bleeding is not synonymous with coagulation disorders. More information is needed to elucidate the pathogenesis of these two entities, DIC with the fibrinolytic phenotype and COT/ACOTS after trauma. However, available data suggest that COT/ACOTS is not a new concept but a disease entity similar to or the same as DIC with the fibrinolytic phenotype.

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Section: Basic Concepts Of Dic With the Fibrinolytic Phenotype And Comentioning

confidence: 99%

Section: Basic Principles Of Hemostasis and Wound Healing In Traumamentioning

confidence: 99%

Differentiating disseminated intravascular coagulation (DIC) with the fibrinolytic phenotype from coagulopathy of trauma and acute coagulopathy of trauma-shock (COT/ACOTS)

Gando

Wada

Thachil

2013

Journal of Thrombosis and Haemostasis

122

137

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“…Early disseminated intravascular coagulation (DIC) and sustained SIRS were demonstrated as strong determinants for post-trauma MOF and late mortality (14). Early trauma-induced DIC, organ damage, and nosocomial infection-induced DIC cooperatively led to continuous DIC that is an independent risk factor for MOF incidence and late mortality in trauma patients (15). Interestingly, coagulation parameters and the clinical course of DIC was significantly different between sepsis and trauma patients (16).…”

Section: Introductionmentioning

confidence: 99%

Damage- and pathogen-associated molecular patterns play differential roles in late mortality after critical illness

Eppensteiner¹,

Kwun²,

Scheuermann³

et al. 2019

JCI Insight

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“…In addition, we previously reported that DIC at an early phase of trauma, which was based on the JAAM DIC criteria and ISTH DIC criteria, continuously progressed to DIC at a late phase until five or six days after the trauma [22]. …”

Section: Discussionmentioning

confidence: 99%

Using angiogenic factors and their soluble receptors to predict organ dysfunction in patients with disseminated intravascular coagulation associated with severe trauma

et al. 2012

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IntroductionDisseminated intravascular coagulation (DIC) is characterized by the concomitant activation of coagulofibrinolytic disorders and systemic inflammation associated with endothelial dysfunction-induced microvascular permeability. Angiogenic factors, including vascular endothelial growth factor (VEGF), angiopoietin (Ang), and their receptors, play crucial roles in angiogenesis and microvascular permeability. The aim of the study was to assess the relationship between angiogenic factors, their soluble receptors and organ dysfunction associated with DIC after severe trauma.Materials and methodsA total of 57 patients with severe trauma were divided into two subgroups; 30 DIC patients and 27 non-DIC patients. The DIC was diagnosed based on the Japanese Association for Acute Medicine (JAAM) DIC and the International Society on Thrombosis and Haemostasis (ISTH) overt DIC criteria. The serum levels of angiogenic factors were measured at the time of admission (Day 1), Day 3 and Day 5. This study compared levels of these angiogenic factors between the two DIC groups, and evaluated their predictive value for organ dysfunction.ResultsDIC patients, especially those with ISTH DIC, showed higher Sequential Organ Failure Assessment (SOFA) scores and lactate levels. There were lower levels of VEGF, Ang1 and the soluble Tie2 in the ISTH DIC patients than the non-DIC patients. The levels of soluble VEGF receptor-1 (sVEGFR1), Ang2 and the Ang2/Ang1 ratio in the ISTH DIC patients were higher than in non-DIC patients. The relationship between the presence of massive transfusion and angiogenic factors indicated the same results. The levels of sVEGFR1, Ang2 and the Ang2/Ang1 ratio correlated with the SOFA scores. In particular, sVEGFR1 and Ang2 were independent predictors of an increase in the SOFA score. The lactate levels independently predicted increases in the levels of sVEGFR1 and Ang2. The decrease in the platelet counts also independently predicted the increase in Ang2 levels in DIC patients.ConclusionsAngiogenic factors and their soluble receptors, particularly sVEGFR1 and Ang2, are considered to play pivotal roles in the development of organ dysfunction in DIC associated with severe trauma. DIC-induced tissue hypoxia and platelet consumption may play crucial roles in inducing sVEGFR1 and Ang2, and in determining the prognosis of the severity of organ dysfunction.

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Disseminated Intravascular Coagulation (DIC) at an Early Phase of Trauma Continuously Proceeds to DIC at a Late Phase of Trauma

Cited by 13 publications

References 14 publications

Differentiating disseminated intravascular coagulation (DIC) with the fibrinolytic phenotype from coagulopathy of trauma and acute coagulopathy of trauma-shock (COT/ACOTS)

Differentiating disseminated intravascular coagulation (DIC) with the fibrinolytic phenotype from coagulopathy of trauma and acute coagulopathy of trauma-shock (COT/ACOTS)

Damage- and pathogen-associated molecular patterns play differential roles in late mortality after critical illness

Using angiogenic factors and their soluble receptors to predict organ dysfunction in patients with disseminated intravascular coagulation associated with severe trauma

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