Unrecognized pulmonary embolism presenting as disseminated intravascular coagulation

Stahl, Robert; Javid, Bahram; Lackner, Henriette

doi:10.1016/0002-9343(84)90985-9

Cited by 31 publications

(21 citation statements)

References 38 publications

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“…Several case reports describing an association between massive PE and DIC are available [6][7][8][9]. However, no data on incidence or severity of DIC in PE patients exist.…”

Section: Introductionmentioning

confidence: 99%

Massive pulmonary embolism leading to cardiac arrest is associated with consumptive coagulopathy presenting as disseminated intravascular coagulation

Leitner

Jilma²,

Spiel

et al. 2010

Journal of Thrombosis and Haemostasis

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To cite this article: Leitner JM, Jilma B, Spiel AO, Sterz F, Laggner AN, Janata KM. Massive pulmonary embolism leading to cardiac arrest is associated with consumptive coagulopathy presenting as disseminated intravascular coagulation. J Thromb Haemost 2010; 8: 1477-82.See also Levi M. Disseminated intravascular coagulation or extended intravascular coagulation in massive pulmonary embolism. This issue, pp 1475-6; Thachil J. DIC score predicts mortality in massive clot coagulopathy as a result of extensive pulmonary embolism: a rebuttal. This issue, pp 1657-8; Leitner JM, Janata-Schwatzek K, Spiel AO, Sterz F, Laggner AN, Jilma B. DIC score predicts mortality in massive clot coagulopathy as a result of extensive pulmonary embolism: reply to a rebuttal. This issue, pp 1658-9.Summary. Background: A consumptive coagulopathy resembling disseminated intravascular coagulation (DIC) has been seen in patients with massive pulmonary embolism (PE). We hypothesized that a DIC-like condition is relevant in patients whose pulmonary embolism leads to cardiopulmonary arrest and cardiopulmonary resuscitation (CPR). Methods: This hypothesis was tested by the use of a database consisting of all cases of PE diagnosed at the Department of Emergency Medicine from June 1993 to October 2007. Out of 1018 cases with PE, 113 patients underwent CPR. In this cohort study, the resuscitated patients were compared with those with PE but without CPR. Results: Patients with PE and CPR had 3-fold higher D-dimer, prolonged prothrombin time (PT), reduced platelet counts and lower fibrinogen and antithrombin (AT) levels compared with PE patients without cardiac arrest (P < 0.001 for all). Among patients with PE and CPR, Ddimer was abnormal in 100%, PT in 44%, AT in 53%, fibrinogen in 19% and platelets in 25%. In comparison, PE without CPR was associated with abnormal D-dimer in 99%, abnormal PT in 15%, low AT in 6%, low fibrinogen in 1% and low platelets in 2%. Nine per cent of the resuscitated patients had a DIC score ‡ 5, indicating overt DIC. The DIC score highly correlated with 1-year and in-hospital mortality. Conclusions: Massive PE leading to CPR is associated with consumptive coagulopathy and overt DIC. In resuscitated patients, DIC markers may indicate pulmonary embolism as the underlying cause of arrest.

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“…Several case reports describing an association between massive PE and DIC are available [6][7][8][9]. However, no data on incidence or severity of DIC in PE patients exist.…”

Section: Introductionmentioning

confidence: 99%

Massive pulmonary embolism leading to cardiac arrest is associated with consumptive coagulopathy presenting as disseminated intravascular coagulation

Leitner

Jilma²,

Spiel

et al. 2010

Journal of Thrombosis and Haemostasis

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“…with acute PE [17], this is rare and usually improves with heparin administration, whereas in our patient, the platelet count fall occurred abruptly soon after receiving LMWH. The ongoing management of venous thromboembolismwith initiation of therapeutic-dose fondaparinux and continuation of warfarin-requires comment.…”

mentioning

confidence: 46%

Chills and limb pain following administration of low‐molecular‐weight heparin for treatment of acute venous thromboembolism

et al. 2011

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“…We hypothesize that these large fresh clots consume platelets on their surface, likely due to the exudation of thromboplastic substances [6,7]. This process can be regarded as a form of disseminated intravascular coagulation (DIC) [8,9]. Thrombocytopenia was seen in these patients early in their course of heparin administration or even prior to any heparin administration.…”

Section: Discussionmentioning

confidence: 99%

Thrombocytopenia due to acute venous thromboembolism and its role in expanding the differential diagnosis of heparin‐induced thrombocytopenia

Kitchens

2004

American J Hematol

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Thrombocytopenia is an uncommon but serious consequence of heparin administration. Occasionally patients with massive acute venous thromboembolism (VTE) will develop thrombocytopenia. As heparin or some thrombin inhibitor is strongly indicated in acute VTE, it is important to distinguish this event from heparin-induced thrombocytopenia (HIT). Four patients are presented who developed thrombocytopenia so early in their course of VTE and/or therapy with heparin that HIT was considered unlikely. The mean nadir platelet count for these four patients was 60,000/ml occurring at a mean time of 18 hr after the initiation of heparin therapy. Because of strong indications to continue heparin for their acute VTE in the face of a very low likelihood that they did have HIT, heparin was continued with excellent results and resolution of the thrombocytopenia. The literature of this subject is reviewed. Thrombocytopenia following VTE is actually rather common, but it is usually milder than in these four cases. In some cases such as these four, the thrombocytopenia can be sudden and rather severe causing diagnostic confusion with HIT. Am.

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Unrecognized pulmonary embolism presenting as disseminated intravascular coagulation

Cited by 31 publications

References 38 publications

Massive pulmonary embolism leading to cardiac arrest is associated with consumptive coagulopathy presenting as disseminated intravascular coagulation

Massive pulmonary embolism leading to cardiac arrest is associated with consumptive coagulopathy presenting as disseminated intravascular coagulation

Chills and limb pain following administration of low‐molecular‐weight heparin for treatment of acute venous thromboembolism

Thrombocytopenia due to acute venous thromboembolism and its role in expanding the differential diagnosis of heparin‐induced thrombocytopenia

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