Comparison of Danaparoid Sodium and Synthetic Protease Inhibitors for the Treatment of Disseminated Intravascular Coagulation Associated with Hematological Malignancies: A Retrospective Analysis

2019 ◽  
Vol 143 (3) ◽  
pp. 250-259 ◽  
Author(s):  
Daisuke Minakata ◽  
Shin-ichiro Fujiwara ◽  
Jin Hayakawa ◽  
Hideki Nakasone ◽  
Takashi Ikeda ◽  
...  
Keyword(s):  
Protease Inhibitors ◽  
Disseminated Intravascular Coagulation ◽  
Clinical Results ◽  
Underlying Disease ◽  
Danaparoid Sodium ◽  
Independent Predictive Factor ◽  
Resolution Rate ◽  
Intravascular Coagulation ◽  
Response To Chemotherapy ◽  
Significant Difference

Background: Danaparoid sodium and synthetic protease inhibitors (SPIs) have been approved for the treatment of disseminated intravascular coagulation (DIC) in Japan. Objectives: To compare the clinical results of the treatment of DIC with danaparoid or SPIs. Methods: We retrospectively examined 188 patients with hematological malignancy-related DIC. Results: DIC resolution rate in the danaparoid group was higher than that in the SPIs group (61.5 vs. 42.6%; p = 0.031) on day 7. Multivariate analysis identified the response to chemotherapy as independent predictive factor for DIC resolution on day 7 (odds ratio, OR, 2.28; 95% confidence interval, CI, 1.21–4.31; p = 0.011). While there was no significant difference in the DIC resolution rate on day 14 (75.0 vs. 62.4%; p = 0.117), in a subgroup analysis of patients who did not show an improvement in the underlying disease, the danaparoid group showed a significantly better DIC resolution rate (OR 3.89; 95% CI 1.15–13.2; p = 0.030). There was no difference in the rate of cumulative mortality from bleeding within 28 days between the 2 groups (6.6 vs. 3.3%; p = 0.278). Conclusions: Danaparoid may be associated with more frequent resolution of DIC in patients with refractory underlying disease.

scholarly journals Attempt to Develop Rat Disseminated Intravascular Coagulation Model Using Yamakagashi (Rhabdophis tigrinus) Venom Injection

Toxins ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 160
Author(s):  
Akihiko Yamamoto ◽  
Takashi Ito ◽  
Toru Hifumi
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Clinical Condition ◽  
Underlying Disease ◽  
Fibrinogen Concentration ◽  
Blood Coagulation Factors ◽  
Fixed Amount ◽  
Intravascular Coagulation ◽  
Measurement Limit ◽  
Human Pathology ◽  
Rhabdophis Tigrinus

Disseminated intravascular coagulation, a severe clinical condition caused by an underlying disease, involves a markedly continuous and widespread activation of coagulation in the circulating blood and the formation of numerous microvascular thrombi. A snakebite, including that of the Yamakagashi (Rhabdophis tigrinus), demonstrates this clinical condition. Thus, an animal model using Yamakagashi venom was constructed. Yamakagashi venom was administered to rats, and its lethality and the changes in blood coagulation factors were detected after venom injection. When 300 μg venom was intramuscularly administered to 12-week-old rats, (1) they exhibited hematuria with plasma hemolysis and died within 48 h; (2) Thrombocytopenia in the blood was observed in the rats; (3) irreversible prolongation of prothrombin time in the plasma to the measurement limit occurred; (4) fibrinogen concentration in the plasma irreversibly decreased below the measurement limit; and (5) A transient increase in the plasma concentration of D-dimer was observed. In this model, a fixed amount of Rhabdophis tigrinus venom injection resulted in the clinical symptom similar to the human pathology with snakebite. The use of the rat model is very effective in validating the therapeutic effect of human disseminated intravascular coagulation condition due to snakebite.

scholarly journals Impact of Antithrombin Supplementation and Concomitant Anticoagulation Therapy in Pediatric Patients With Disseminated Intravascular Coagulation

2019 ◽  
Vol 25 ◽  
pp. 107602961983435
Author(s):  
Hiroyuki Nagafuchi ◽  
Yutaka Eguchi ◽  
Toshiaki Ikeda
Keyword(s):  
Organ Failure ◽  
Disseminated Intravascular Coagulation ◽  
Pediatric Patients ◽  
Anticoagulation Therapy ◽  
Standardized Mortality Ratio ◽  
Efficacy And Safety ◽  
Resolution Rate ◽  
Intravascular Coagulation ◽  
Failure Assessment ◽  
Mortality Ratio

We aimed to evaluate the efficacy and safety of antithrombin (AT) supplementation and concomitant anticoagulation therapy in 65 children who met the Japanese Ministry of Health and Welfare (JMHW) disseminated intravascular coagulation (DIC) criteria and had received AT concentrate and/or other concomitant anticoagulants. The primary efficacy end point was to determine standardized mortality ratio (SMR). The secondary efficacy end points were DIC resolution rate and pediatric sequential organ failure assessment (pSOFA) score on day 3. The 28-day mortality rate was 6.8%; SMR was 0.55. Disseminated intravascular coagulation resolution rate on day 3 was 54.5%. The JMHW DIC scores at day 0 ( P = .005) and pSOFA scores at day 3 ( P = .018) were significantly lower in patients with resolution of DIC than in those without resolution of DIC. The target cutoff value for JMHW DIC score on day 0 was 6. No bleeding-related adverse events were associated with AT administration. In children with DIC, AT supplementation and concomitant anticoagulation therapy can be safely used as initial treatment when JMHW DIC score is 6; it may improve DIC resolution, organ failure, and mortality rates.

scholarly journals Aneurysm-related disseminated intravascular coagulation successfully treated by endovascular repair

2019 ◽  
Vol 11 (4) ◽  
Author(s):  
Miguel Lemos Gomes ◽  
Alice Lopes ◽  
Ana Parente Freixo ◽  
Gonçalo Sobrinho ◽  
Ruy Fernandes ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Disseminated Intravascular Coagulation ◽  
Endovascular Aneurysm Repair ◽  
Underlying Disease ◽  
Abdominal Aneurysm ◽  
Laboratory Findings ◽  
Intravascular Coagulation ◽  
Abdominal Aortic ◽  
Internal Iliac ◽  
Aneurysm Repair

Aortic abdominal aneurysm (AAA) is an uncommon etiology of disseminated intravascular coagulation (DIC). The authors report a case of an 81-year-old male patient who presented with hematuria, intraoral hemorrhage, melaenas and ecchymosis of the lower back and of the abdominal wall, after being medicated with etoricoxib for a back pain. During the study, an abdominal aortic aneurysm, which prolonged to the left common and internal iliac artery, was discovered. The diagnosis of AAA induced DIC was made. After endovascular aneurysm repair (EVAR), the patient’s hemorrhagic manifestations disappeared and the laboratory findings normalized. In conclusion, the state-of-the-art treatment of DIC is the elimination of the underlying disease; in this case, EVAR was proven to be effective in treating the aortic aneurysm and the AAA-related DIC.

The Pathophysiology of Disseminated Intravascular Coagulation

1999 ◽  
Vol 82 (08) ◽  
pp. 713-717 ◽  
Author(s):  
Janneke Timmerman ◽  
Marcel Levi ◽  
Hugo ten Cate
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Factor Viia ◽  
Underlying Disease ◽  
Gram Negative Bacteria ◽  
Catalytic Complex ◽  
Gram Negative ◽  
Intravascular Coagulation ◽  
Disease States ◽  
Wide Range ◽  
A Cell

IntroductionDisseminated intravascular coagulation (DIC) can be defined as “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.”1 Being an acquired disorder, DIC occurs in a wide range of underlying disease states, including sepsis (both by Gram positive and Gram negative bacteria), burns, preeclampsia, malignancy, and polytrauma.1 In the majority of conditions, the pathogenesis of DIC remains only partly understood, an exception is Gram negative septicemia. In the following chapter, we will discuss the presumed mechanism by which DIC is elicited in different pathological states. The initiation of DIC follows the presentation of the glycoprotein tissue factor (TF) at a cellular surface, being either an intact or perturbed cell, or a cell membrane remnant.2 The extracellular TF molecules may interact with circulating factor VIIa to form a catalytic complex. The complex binds the coagulation zymogen factors IX and X. This leads to proteolytic cleavage of these molecules, yielding enzymatically active factors IXa and Xa and promoting the activation of prothrombin to thrombin (Fig. 1).

scholarly journals Effect of High-dose Antithrombin Supplementation in Patients with Septic Shock and Disseminated Intravascular Coagulation

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Youn-Jung Kim ◽  
Byuk Sung Ko ◽  
Seo Young Park ◽  
Dong Kyu Oh ◽  
Sang-Bum Hong ◽  
...  
Keyword(s):  
Septic Shock ◽  
Disseminated Intravascular Coagulation ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
High Dose ◽  
Inverse Probability ◽  
Intravascular Coagulation ◽  
Significant Difference ◽  
Observational Prospective Cohort Study ◽  
Improvement In Survival

Abstract The efficacy of antithrombin (AT) administration in patients with septic shock and disseminated intravascular coagulation (DIC) was uncertain. This study aimed to investigate whether high-dose AT administration improves outcomes in patients with septic shock and DIC. This observational, prospective cohort study included consecutive adult septic shock patients with DIC who showed AT activity <70% between March 2016 and August 2018. The 28 day mortality of the patients treated with AT and without AT was evaluated by propensity score matching and inverse probability of treatment weighting. Among 142 patients with septic shock and DIC, 45 patients (31.7%) received AT supplementation and 97 did not. The 28 day mortality rate was lower in the AT group, but no statistically significant difference persisted after matching. Multivariable analysis showed that AT supplementation was independently associated with 28 day mortality (odds ratio [OR], 0.342; 95% CI [confidence interval], 0.133−0.876; P = 0.025); however, no such association was observed after matching (OR, 0.480; 95% CI, 0.177−1.301; P = 0.149). High-dose AT administration in septic shock patients with DIC showed the improvement in survival, but the improvement was not observed after matching. Further larger studies are needed to conclusively confirm these findings.

scholarly journals Management of Chronic Disseminated Intravascular Coagulation Associated with Aortic Aneurysm/Dissection

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Shigeru Koba ◽  
Tomoya Yamaguchi ◽  
Kenji Miki ◽  
Hiroshi Makihara ◽  
Shinsaku Imashuku
Keyword(s):  
Aortic Aneurysm ◽  
Elderly Patients ◽  
Disseminated Intravascular Coagulation ◽  
Underlying Disease ◽  
Hemorrhagic Diathesis ◽  
Disease Extent ◽  
Intravascular Coagulation ◽  
Life Threatening ◽  
Aneurysm Dissection ◽  
Uncertain Etiology

Disseminated intravascular coagulation (DIC) is a systemic life-threatening process that can cause thrombosis and hemorrhage. Chronic DIC has been associated with aortic aneurysm/dissection. Aortic aneurysm/dissection should be included in the differential diagnosis of elderly patients with hemorrhagic diathesis due to DIC of uncertain etiology. Treatment depends on various factors, including the severity of underlying disease, extent of DIC, and patient comorbidities, as well as the ability of the patient to maintain activities of daily living once discharged from the hospital. This report describes the clinical characteristics of four elderly patients with chronic DIC associated with aortic aneurysm/dissection who were treated in our institution. We also offer the recommendations around most appropriate nonsurgical treatment of these patients.

scholarly journals DIAGNOSTIC CRITERIA FOR DISSEMINATED INTRAVASCULAR COAGULATION SYNDROME AND SEPSIS-INDUCED COAGULOPATHY

2021 ◽  
pp. 25-38
Author(s):  
S. O. Tarasenko ◽  
S. O. Dubrov ◽  
G. G. Suslov
Keyword(s):  
Intensive Care ◽  
Clinical Practice ◽  
Disseminated Intravascular Coagulation ◽  
Thrombus Formation ◽  
Clinical Manifestations ◽  
Underlying Disease ◽  
Multiple Organ ◽  
Review Of The Literature ◽  
Intravascular Coagulation ◽  
Current State

The clinical manifestations of disseminated intravascular coagulation syndrome (DIC) depend on the predominance of the sum of the vectors of hypercoagulation and hyperfibrinolysis and are strongly associated with the underlying disease, against which DIC is formed. The issue of understanding the complex pathogenesis, timely diagnosis of overt DIC and early manifestations of DIC remain an urgent challenge for intensive care physicians and leading specialized societies to study the problems of hemostasis and thrombus formation. This review of the literature analyzes the pathways of DIC development, the current state of the possibility of using diagnostic markers to detect DIC, especially in sepsis. The diagnosis of sepsis-induced coagulopathy against the background of the development of multiple organ failure is highlighted as a separate issue. Diagnostic scales are presented in the form of comparative tables for a more convenient perception of information, memorization and further implementation in clinical practice.

Laboratory Diagnostics in Septic Disseminated Intravascular Coagulation

2009 ◽  
Vol 03 (01) ◽  
pp. 19
Author(s):  
Giuseppe Lippi ◽  
Gian Cesare Guidi ◽  
◽  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Coagulation Factors ◽  
Underlying Disease ◽  
Laboratory Diagnostics ◽  
Diagnostic Efficiency ◽  
Intravascular Coagulation ◽  
Diagnostic Algorithms ◽  
Clinical Signs And Symptoms

The diagnosis of septic disseminated intravascular coagulation (DIC) relies on clinical signs and symptoms, identification of the underlying disease and results of laboratory testing. Since no single test result alone can definitely establish or rule out the diagnosis, the laboratory diagnostics of septic DIC encompass a combination of tests for which simple diagnostic algorithms are now available. Global tests of haemostasis provide evidence of activation of blood coagulation and, ultimately, consumption of coagulation factors, but their diagnostic efficiency is as yet questionable. Fibrinolytic markers, namely D-dimer, reflect the extent of activation of both coagulation and fibrinolysis, so a normal value can be used in a ruling-out strategy. Decreased levels of the natural inhibitors are frequently observed in patients with septic DIC, but antithrombin and protein C measurements are not incorporated in any of the widely used diagnostic algorithms. Among the inflammatory biomarkers, procalcitonin is currently regarded as the gold standard to differentiate the type of infection and guide antibiotic therapy, but its clinical usefulness in identifying and predicting the outcome of patients with septic DIC is still circumstantial.

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