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2214 Part XII: Hemostasis and Thrombosis Chapter 129: Disseminated Intravascular Coagulation 2215

and purpura fulminans, intravenous bolus injection of 5000 to 10,000 14. Lasch HG, Heene DL, Huth K, et al: Pathophysiology, clinical manifestations and ther-
U heparin may be given simultaneously with replacement therapy with apy of consumption-coagulopathy (“Verbrauchskoagulopathie”). Am J Cardiol 20:381,
1967.
blood products. Some experts would not administer a bolus dose of 15. Merskey C, Johnson AJ, Kleiner GJ, et al: The defibrination syndrome: Clinical features
heparin even under these circumstances. Continuous infusion of 500 and laboratory diagnosis. Br J Haematol 13:528, 1967.
to 1000 U/h heparin may be necessary to maintain the benefit until the 16. Robboy SJ, Major MC, Colman RW, et al: Pathology of disseminated intravascular
coagulation (DIC). Analysis of 26 cases. Hum Pathol 3:327, 1972.
underlying disease responds to treatment. 339 17. Wilde JT, Roberts KM, Greaves M, et al: Association between necropsy evidence of dis-
Theoretically, the most logical anticoagulant agent to use in DIC is seminated intravascular coagulation and coagulation variables before death in patients
directed against TF activity. Potential agents include recombinant TFPI, in intensive care units. J Clin Pathol 41:138, 1988.
inactivated factor VIIa, and recombinant nematode anticoagulant pro- 18. Kim HS, Suzuki M, Lie JT, et al: Clinically unsuspected disseminated intravascular
coagulation (DIC): An autopsy survey. Am J Clin Pathol 66:31, 1976.
tein c2 (NAPc2), a potent and specific inhibitor of the ternary complex 19. Watanabe T, Imamura T, Nakagaki K, et al: Disseminated intravascular coagulation
of TF–factor VIIa and factor Xa. Phase II trials of recombinant TFPI in autopsy cases. Its incidence and clinicopathologic significance. Pathol Res Pract
340
341
in patients with sepsis showed promising results, but a phase III trial 165:311, 1979.
did not show an overall survival benefit in patients who were treated 20. Shimamura K, Oka K, Nakazawa M, et al: Distribution patterns of microthrombi in
disseminated intravascular coagulation. Arch Pathol Lab Med 107:543, 1983.
with TFPI. 341,342 21. Levi M, van der Poll T, ten Cate H, et al: The cytokine-mediated imbalance between
Recombinant human soluble thrombomodulin binds to thrombin coagulant and anticoagulant mechanisms in sepsis and endotoxaemia. Eur J Clin Invest
27:3, 1997.
to form a complex that inactivates thrombin’s coagulant activity and 22. Levi M, van der Poll T, Buller HR: The bidirectional relationship between coagulation
activates protein C, and thus, is a potential drug for the treatment of and inflammation. Circulation 109:2698, 2004.
patients with DIC. In a phase III randomized double-blind clinical trial 23. Aird WC: Vascular bed-specific hemostasis: Role of endothelium in sepsis pathogene-
in patients with DIC, administration of the soluble thrombomodulin sis. Crit Care Med 29:S28, 2001.
had a significantly better effect on bleeding manifestations and coagula- 24. Weinbaum S, Zhang X, Han Y, et al: Mechanotransduction and flow across the endothe-
lial glycocalyx. Proc Natl Acad Sci U S A 100:7988, 2003.
343
tion parameters than heparin. Ongoing trials with soluble thrombo- 25. Maczewski M, Duda M, Pawlak W, et al: Endothelial protection from reperfusion
modulin focus on DIC, organ failure, and mortality rate. injury by ischemic preconditioning and diazoxide involves a SOD-like anti-O -mecha-
2
nism. J Physiol Pharmacol 55:537, 2004.
26. Vink H, Constantinescu AA, Spaan JA: Oxidized lipoproteins degrade the endothelial
INHIBITORS OF FIBRINOLYSIS surface layer: Implications for platelet-endothelial cell adhesion. Circulation 101:1500,
2000.
Patients with DIC should not be treated with antifibrinolytic agents 27. Nieuwdorp M, van Haeften TW, Gouverneur MC, et al: Loss of endothelial glycocalyx
such as ε-aminocaproic acid or tranexamic acid because these drugs during acute hyperglycemia coincides with endothelial dysfunction and coagulation
activation in vivo. Diabetes 55:480, 2006.
block fibrinolysis that preserves tissue perfusion in patients with DIC. 28. Levi M, van der Poll T, ten Cate H: Tissue factor in infection and severe inflammation.
Use of these agents in patients with DIC has been complicated by severe Semin Thromb Hemost 32:33, 2006.
thrombosis. 344,345 29. Taylor FBJ, Chang A, Ruf W, et al: Lethal E. coli septic shock is prevented by blocking
tissue factor with monoclonal antibody. Circ Shock 33:127, 1991.
A different situation prevails in patients with DIC accompanied by 30. Levi M, ten Cate H, Bauer KA, et al: Inhibition of endotoxin-induced activation of
primary fibrino(geno)lysis, as in some cases of APL, giant hemangioma, coagulation and fibrinolysis by pentoxifylline or by a monoclonal anti-tissue factor
heat stroke, amniotic fluid embolism, some forms of liver disease, and antibody in chimpanzees. J Clin Invest 93:114, 1994.
metastatic carcinoma of the prostate. In these conditions, the use of 31. van der Poll T, Levi M, Hack CE, et al: Elimination of interleukin 6 attenuates coagula-
tion activation in experimental endotoxemia in chimpanzees. J Exp Med 179:1253, 1994.
fibrinolytic inhibitors can be considered, provided (1) the patient is 32. Osterud B, Rao LV, Olsen JO: Induction of tissue factor expression in whole blood—
346
bleeding profusely and has not responded to replacement therapy and Lack of evidence for the presence of tissue factor expression on granulocytes. Thromb
Haemost 83:861, 2000.
(2) excessive fibrino(geno)lysis is observed, that is, rapid whole blood 33. Franco RF, de Jonge E, Dekkers PE, et al: The in vivo kinetics of tissue factor messenger
clot lysis or a very short euglobulin lysis time. In such circumstances, RNA expression during human endotoxemia: Relationship with activation of coagula-
use of antifibrinolytic agents should be preceded by replacement of tion. Blood 96:554, 2000.
depleted blood components and continuous heparin infusion (see 34. Rauch U, Bonderman D, Bohrmann B, et al: Transfer of tissue factor from leukocytes to
platelets is mediated by CD15 and tissue factor. Blood 96:170, 2000.
Fig. 129–4). 35. Osterud B, Bjorklid E: Sources of tissue factor. Semin Thromb Hemost 32:11, 2006.
36. van Deventer SJ, Buller HR, ten Cate JW, et al: Experimental endotoxemia in humans:
Analysis of cytokine release and coagulation, fibrinolytic, and complement pathways.
REFERENCES 37. Boermeester MA, van Leeuwen P, Coyle SM, et al: Interleukin-1 blockade attenuates
Blood 76:2520, 1990.
1. McKay DG: Disseminated Intravascular Coagulation: an Intermediary Mechanism of mediator release and dysregulation of the hemostatic mechanism during human sepsis.
Disease. Hoeber Medical, New York, 1965. Arch Surg 130:739, 1995.
2. Mammen EF: Disseminated intravascular coagulation (DIC). Clin Lab Sci 13:239, 2000. 38. Osterud B: Tissue factor expression by monocytes: Regulation and pathophysiological
3. Colman RW, Robboy SJ, Minna JD: Disseminated intravascular coagulation: A reap- roles. Blood Coagul Fibrinolysis 9 Suppl 1:S9, 1998.
praisal. Annu Rev Med 30:359, 1979. 39. Furie B, Furie BC: Role of platelet P-selectin and microparticle PSGL-1 in thrombus
4. Seligsohn U: Disseminated intravascular coagulation, in Blood: Principles and Practice formation. Trends Mol Med 10:171, 2004.
of Hematology, edited by RI Handin, SE Lux, TP Stossel, p 1289. J.B. Lippincott, Phila- 40. Neumann FJ, Marx N, Gawaz M, et al: Induction of cytokine expression in leukocytes
delphia, 2000. by binding of thrombin-stimulated platelets. Circulation 95:2387, 1997.
5. Levi M, ten Cate H: Disseminated intravascular coagulation. N Engl J Med 341:586, 41. Esmon CT: Protein C anticoagulant pathway and its role in controlling microvascular
1999. thrombosis and inflammation. Crit Care Med 29:S48, 2001.
6. Levi M, ten Cate H, van der Poll T: Disseminated intravascular coagulation: State of the 42. Mileno MD, Margolis NH, Clark BD, et al: Coagulation of whole blood stimulates
art. Thromb Haemost 82:695, 1999. interleukin-1 beta gene expression. J Infect Dis 172:308, 1995.
7. Levi M: Disseminated intravascular coagulation. Crit Care Med 29:2191, 2007. 43. Jones A, Geczy CL: Thrombin and factor Xa enhance the production of interleukin-1.
8. Dupuy M: Injections de matière cérébrale dans les veines. Gaz Med (Paris) 2:524, 1834. Immunology 71:236, 1990.
9. Trousseau A: Phlegmasia alba dolens. Clin Med Hotel Dieu Paris 695, 1865. 44. Johnson K, Choi Y, DeGroot E, et al: Potential mechanisms for a proinflammatory vas-
10. Naunyn C: Untersuchungen uber Blutgerinnung im lebenden tiere and ihre Folgen. cular cytokine response to coagulation activation. J Immunol 160:5130, 1998.
Arch Exp Pathol Pharmacol 1873. 45. Sower LE, Froelich CJ, Carney DH, et al: Thrombin induces IL-6 production in fibrob-
11. Woolridge LC: Note on the relation of the red cell corpuscles to coagulation. Practi- lasts and epithelial cells. Evidence for the involvement of the seven-transmembrane
tioner 187, 1886. domain (STD) receptor for alpha-thrombin. J Immunol 155:895, 1995.
12. Woolridge LC: Ueber intravasculare gerinnungen. Arch Ant Physiol Abt (Leipzig) 397, 46. van der Poll T, de Jonge E, Levi M: Regulatory role of cytokines in disseminated intra-
1886. vascular coagulation. Semin Thromb Hemost 27:639, 2001.
13. Ratnoff OD, Pritchard JA, Colopy JE: Hemorraghic states during pregnancy. N Engl J 47. Coughlin SR: Thrombin signalling and protease-activated receptors. Nature 407:258,
Med 253:63, 1955. 2000.

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