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Query: UMLS:C0012739 (disseminated intravascular coagulation)
 8,673 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The treatment of disseminated intravascular coagulation (DIC) in infants with sepsis should be instituted after multimodality therapy of pyo-inflammatory diseases taking into account the degree of hemostatic disorders. In stage I DIC (hypercoagulation one), it is necessary to reach an adequate level of the inhibitors of the thrombin and plasmin systems. In this case it is quite sufficient to use donor's cryoplasma without heparin administration. In stage II DIC (transitory one) and stage III (hypocoagulation one), it is required that the drugs possessing antithrombin and antiplasmin activity, substitution therapy with blood preparations and components as well as measures to control hemorrhagic diathesis may be used.
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PMID:[Disseminated intravascular coagulation in newborn infants with infection]. 276 53

Disseminated intravascular coagulation, thrombocytopenia, consumption of factors VIII and II, and antithrombin deficiency have been previously demonstrated in pre-eclampsia. However, the precise mechanism responsible for initiation of disseminated intravascular coagulation has not been elucidated. The present study documents activation of the intrinsic coagulation pathway in a patient with severe pre-eclampsia. The studies revealed marked reductions of plasma coagulant activities of all intrinsic pathway factors, i.e., XII, XI, IX, and VIII. In addition, the ratio of plasma factor XII activity to antigen concentration was markedly abnormal, and plasma high-molecular-weight kininogen concentration was diminished. It is suggested that activation of the intrinsic coagulation pathway may be operative in the genesis of disseminated intravascular coagulation in pre-eclampsia.
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PMID:Activation of intrinsic coagulation pathway in pre-eclampsia. 2870 53

Comparative studies in early treatment for DIC caused by circulatory arrest were carried out on three groups of dogs during 300 min from the recovery of circulatory arrest: a heparin group, a FOY (gabexate mesilate) group, and a FUT-175 (nafamostat mesilate) group. The parameters employed were platelet count, prothrombin time (PT), activated partial prothrombin time (APTT), fibrinogen, antithrombin-III (AT-III), and fibrin or fibrinogen degradation products (FDP). In the heparin group, there was less of a drop in the platelet count and the level of AT-III than in the control group, but the FDP levels were the same as in the control group. The PT and APTT remained within normal limits in the FOY group and no decrease was observed in either platelet count or AT-III levels. In addition, FDP levels were kept within normal limits. In the FUT-175 group, prolongation of APTT, no decline in the platelet count and AT-III levels, and normal levels of FDP were observed. The results of these experiments indicate the importance of early treatment for DIC. Judging from the parameters, better results were obtained in the FOY and FUT-175 group than in the heparin group.
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PMID:Studies on the effects of primary therapy for DIC following circulatory arrest. 308 85

The pharmacokinetics of recombinant hirudin were studied in 9 healthy subjects after single intravenous, subcutaneous or intramuscular doses of 0.1 mg/kg. Generally, administration of r-hirudin was tolerated without side effects. An assay was used which detects the inhibitor in blood and urine by its antithrombin activity. Absorption, distribution and elimination of r-hirudin were found to be corresponding to the results obtained with native hirudin. The effects on the haemostatic system were evaluated. Thrombin time and partial thromboplastin time were prolonged dependent on the r-hirudin plasma level. Platelet counts, fibrinogen level and fibrinolytic system were unchanged. Bleeding time was not prolonged. After administration of r-hirudin in case of chronic DIC, fibrinogen level, platelet counts and fibrin monomers transiently returned to normal values.
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PMID:Clinico-pharmacological studies with recombinant hirudin. 322 82

A detailed review of the dynamic processes of coagulation and fibrinolysis precedes a discussion of clinical applications, especially for users of oral contraception and others with antithrombin-III disorders. Coagulation and fibrinolysis are both initiated by activation of circulating pro-enzymes, namely thrombin and plasmin. Both of these have circulating and local inhibitors that modify stages of the clotting and fibrinolytic processes. The circulating system, also called the intrinsic coagulation system, can be regarded as an amplification system related to the extrinsic, or cellular system. Antithrombin-III (AT-III) is a specific plasma protein that inhibits coagulation at the step (after platelets aggregate) of fibrin formation. At-III can be measured immunologically, or functionally by its ability to bind thrombin in the presence of heparin. Familial AT-III deficiencies incur a risk of venous thrombosis, and may be total or partial, depending on the type of genetic defect. Affected individuals may be treated with vitamin-K antagonists, anabolic steroids, or subcutaneous, low-dose heparin. Episodes of thrombosis may also represent acquired AT-III deficiency, such as in pregnancy, abortion, post-surgery, or disseminated intravascular coagulation. The approximately 10% decrease in AT-III seen in women taking estrogen-containing oral contraceptives is within normal limits. The oral route is significant, as AT-III is a protein made by the liver. This fall is not of any physiological significance, since the plasma euglobulin fibrinolytic system is also increased. Some pill users with AT-III deficiency or other thrombosis-prone conditions, however, may be at risk of increased thrombosis.
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PMID:Pathophysiology and clinical aspects of fibrinolysis and inhibition of coagulation. Experimental and clinical studies with special reference to women on oral contraceptives and selected groups of thrombosis prone patients. 327 96

Human plasma contains two distinct heparin dependent thrombin inhibitors; antithrombin III (ATIII) and Heparin cofactor II (HCII). The latter is also known as antithrombin BM, because of its moderate binding affinity to heparin. The protein is distinct from ATIII by immunological and functional criteria as well as by its amino acid sequence. HCII selectively inhibits thrombin by forming a 1:1 molar complex with the protease and has no activity towards other coagulation serine proteases. Dermatan sulphate, a glycosaminoglycan, specifically activates HCII and increases its thrombin neutralizing activity by over a thousand fold. Dermatan sulphate does not catalyze the activity of ATIII. Human fibroblasts have been shown to accelerate the neutralization of thrombin by HCII. These cells can synthesize proteoglycans containing dermatan sulphate. Current evidence would thus suggest that extravascular tissues are the major sites of action of HCII. The specificity of dermatan sulphate for HCII has allowed the development of functional assays for this protein. Reduced levels have been observed in patients with significant hepatocellular dysfunction and in association with disseminated intravascular coagulation. Two families have been reported with hereditary HCII deficiency and recurrent thrombosis (both venous and arterial). Although these observations suggest a role for HCII in the modulation of hemostatic system, further studies are required to define the importance of HCII deficiency as a marker of thrombosis.
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PMID:The role of heparin cofactor II in the modulation of hemostasis. 330 69

Gram-negative septic shock remains a major clinical problem. One frequently encountered complication of sepsis is disseminated intravascular coagulation (DIC). The present study was to determine in an Escherichia coli endotoxemia awake rat model the efficacy of antithrombin-III (AT-III) prophylaxis and to explore the role of DIC in the pathogenesis of endotoxemia. We demonstrated that DIC occurs very early, before the appearance of detectable serious abnormalities in cardiovascular, metabolic, and biochemical variables indicative of organ damage or dysfunction; AT-III prophylaxis significantly ameliorates DIC, as evidenced by completely preventing the fall in plasma fibrinogen concentration and significantly limiting the increases in prothrombin time and activated partial thromboplastin time after 4 hours of endotoxemia; and AT-III prophylaxis dramatically increases permanent survival. Results of this study suggest that AT-III prophylaxis is very protective above a threshold dosage in an endotoxemic rat model and that protection is in part due to ameliorating DIC. Our data also suggest that DIC occurs very early during endotoxemia and may in part be responsible for the pathogenesis of endotoxemia in the rat. We conclude that AT-III prophylaxis may be efficacious in conditions of impending DIC, such as gram-negative septicemia/endotoxemia.
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PMID:Protection against disseminated intravascular coagulation and death by antithrombin-III in the Escherichia coli endotoxemic rat. 354 29

In vitro coagulation produces a consumption of heparin co factor II (HC II) of 8-10% both in plasma from normal individuals and patients whereas antithrombin (AT) consumption ranges 40-50%. In blood from heparin treated patients consumption is similar or greater. In blood from warfarin treated patients, consumption is decreased. Addition of heparin prior to clotting has little effect on HC II consumption, but high heparin concentration reduces AT consumption. Addition of dermatan sulfate has no effect on AT consumption, but increases HC II consumption dramatically. In consumption coagulopathy, the HC II levels are as low as AT, possibly reflecting intravascular consumption accelerated by vascular glycosaminoglycans.
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PMID:Consumption of heparin cofactor II (dermatan sulfate cofactor) and antithrombin during coagulation. 360 28

Numerous investigators have postulated that a hypercoagulable state exists in humans for a period of time before the development of thrombotic episodes. A clear biochemical definition of the prethrombotic state, however, has proved elusive due in part to the lack of reliable techniques for monitoring pertinent changes in blood coagulability. Based on recent advances in our knowledge of the biochemistry of the coagulation system, a series of highly sensitive and specific immunochemical tools has been developed that can quantitate the activities of various steps of the hemostatic mechanism in vivo at the subnanomolar level. We have established assays for F1+2 and the protein C activation peptide, which measure the cleavage of the prothrombin molecule by factor Xa and the scission of protein C by the thrombin-thrombomodulin complex, respectively. Nossel and coworkers had previously constructed similar assays for fibrinopeptide A (FPA) and fragment B beta 1-42, which monitor the cleavage of fibrinogen by thrombin and the proteolysis of fibrin I by plasmin, respectively. Substantial elevations in the levels of these markers have been found in patients with disseminated intravascular coagulation and many subjects with acute deep venous thrombosis. The F1+2 and FPA assays have been used to demonstrate that significant increments in factor Xa activity but not thrombin activity regularly occur in the blood of nonanticoagulated individuals with congenital deficiencies of antithrombin or protein C. These two disorders are known to be correlated with the subsequent development of thrombosis. Patients with protein C deficiency have also been noted to have significantly reduced plasma levels of protein C activation peptide. By using the immunoassays for FPA and B beta 1-42 in studies of postoperative patients, it has been shown that an imbalance between the procoagulant action of thrombin and the anticoagulant effect of plasmin on fibrin I polymer may induce an acquired thrombotic diathesis. Finally, we have recently demonstrated that prothrombin activation as measured by the F1+2 assay is suppressed by oral anticoagulants in the blood of patients with thrombotic diatheses. These investigations suggest that these assay techniques can be used to improve our understanding of the hypercoagulable state as well as to develop more effective treatment strategies for the prevention of thromboembolic events.
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PMID:The pathophysiology of the prethrombotic state in humans: insights gained from studies using markers of hemostatic system activation. 360 75

Antithrombin-III assays are performed to assess response to heparin therapy and efficacy of antithrombin concentrate therapy and in diagnosing hereditary thrombophilia, deep venous thrombosis, pulmonary embolus, and disseminated intravascular coagulation. Synthetic substrate assays for antithrombin-III are the methods of choice; however, most existing assay systems are semiautomated. A fully automated, antithrombin-III assay using the Kabi Chromogenic Synthetic Substrate S-2238 COATEST on the MULTISTAT III has been developed. This assay was compared with the Dade Protopath fluorometric assay. The correlation (r-sq) between the two assay systems was 0.82. Additionally, a three-way assay comparison was also performed, incorporating a new fluorometric substrate for antithrombin-III. The three-way comparative assays revealed correlation as follows: MULTISTAT III fluorometric assay and the MULTISTAT III/Kabi COATEST assay r-sq = 0.90; MULTISTAT III fluorometric assay and the Dade fluorometric assay r-sq = 0.86; and the MULTISTAT III/Kabi COATEST assay and the Dade Protopath fluorometric assay r-sq = 0.95. These automated assays were extremely cost effective and were a fraction of the cost of performing other types of antithrombin-III assays.
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PMID:Fully automated antithrombin-III assays by synthetic substrate on the Multistat III. 361 51


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