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

We examined plasma levels of activated factor VII (F VIla) in 50 patients positive for lupus anticoagulant (LA), in 83 patients negative for LA, and in 10 healthy volunteers as controls. Plasma F VIIa was present in healthy volunteers; its level was significantly increased, compared to the level in the controls, in patients with thrombosis, collagen diseases, and disseminated intravascular coagulation (DIC), suggesting that it reflected a thrombotic state. Plasma F VIIa was correlated with thrombin-antithrombin complex (TAT) in patients negative for LA but showed no such correlation in those positive for LA. Plasma F VIIa was negatively correlated with activated partial thromboplastin time (APTT) in patients positive for LA, but not in those negative for LA, suggesting that LA could inhibit the F VIIa assay system. Plasma F VIIa level was significantly increased in patients with thrombotic diseases; however, in patients positive for LA, it is possible that increased plasma F VIIa level may not be correlated with thrombogenicity.
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PMID:Plasma-activated factor VII level in patients positive for lupus anticoagulant. 913 11

Plasma coagulation results from 2,100 injured patients were sequentially and systematically evaluated in a large natural history study of neurotrauma. A significant correlation became apparent between the severity of and morbidity from head injury and the degree of abnormality in coagulation results, especially for young injured victims. Subsequent studies in the United States, Europe, and Japan have supported the significant correlation between final clinical outcome and these measurements of plasma coagulation, as well as inflammatory proteins, performed soon after injury. This discussion reviews the data from many published reports that support this conclusion, especially data that corroborate the strong clinical association between head trauma and disseminated intravascular coagulation (DIC). The data that demonstrate a high predisposition for head-injured individuals to develop DIC serve as a the rationale for therapeutic intervention with coagulation protease inhibitors, especially antithrombin (AT). A large, double-blind, placebo-controlled trial that evaluates the therapeutic use of AT concentrate for DIC in such patients has yet to be completed. Described here is the design for such a clinical trial that examined the impact of mortality as an outcome. However, this trial was terminated for nonscientific reasons soon after it began. Very truncated data collected from this aborted study support both the scientific rationale for and the feasibility of such a study in the future. Data from such a clinical trial are needed to support the use of AT concentrate to treat DIC in this and other morbid diseases.
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PMID:Experience with antithrombin concentrates in neurotrauma patients. 915 17

Hemorrhage, head injury, and multiple organ dysfunction are the most frequent causes of mortality in patients who experience severe injury. Acceleration of the coagulation cascade is known to result in hemorrhage secondary to disseminated intravascular coagulation (DIC) and end-organ dysfunction, as manifest by pulmonary and renal failure. Few studies have been conducted to evaluate the effects of injury on the endogenous anticoagulants that inhibit excessive coagulation activation. We evaluated a group of patients following severe injury and found that procoagulant markers (prothrombin fragment 1.2, thrombin antithrombin complexes, and D dimers) were significantly elevated for the population as a whole. Levels of circulating endogenous anticoagulants [antithrombin (AT) and protein C] were relatively unchanged for the total population. However, patients with adverse outcomes [DIC and adult respiratory distress syndrome (ARDS)] had significant reductions in AT and protein C activities. Decreased levels of AT and protein C 8 hours after admission served as independent predictors of both DIC and ARDS. Prospective, randomized studies should be conducted to evaluate the effect of supplementation of these factors after severe injury has occurred.
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PMID:Acquired antithrombin deficiency following severe traumatic injury: rationale for study of antithrombin supplementation. 915 18

Disseminated intravascular coagulation (DIC) may lead to severe thrombotic or hemorrhagic complications. The present work was undertaken to study the effect of interleukin 6 (IL-6) on variations of key coagulation and fibrinolytic parameters in plasma in a baboon model of experimental DIC induced by injection of factor Xa and phospholipids at dosages leading to partial (48%) or complete fibrinogen depletion. Transient increases of D-dimer, fibrinopeptide A, thrombin-antithrombin and the activated partial thromboplastin time were observed. Each parameter had a particular (time and Xa/phospholipid dose dependent) pattern of changes. The principal effect of IL-6 was a more rapid restoration of fibrinogen concentrations and of overall coagulation tests. Injection of factor Xa/phospholipids led also to a rapid increase of tissue-type plasminogen activator (t-PA) the extent of which was dependent on Xa/phospholipid dose. Pretreatment with IL-6 induced a threefold increase of basal t-PA and a corresponding increase of the t-PA response. Plasminogen activator inhibitor type 1 (PAI-1) concentrations did not change after low dose Xa/phospholipids, but increased eightfold after high dose Xa/phospholipids, IL-6 pretreatment induced within 8 h a twentyfold increase of PAI-1 but no further increase was observed after injection of factor Xa/phospholipids. Thus, in vivo thrombin generation leads to dynamic modifications of the coagulation and fibrinolytic systems. The principal effect of IL-6 is a more rapid normalization of overall coagulation tests, due to normalization of fibrinogen, and an increased t-PA release response which is partially counteracted by increased PAI-1 concentrations.
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PMID:The coagulation and fibrinolytic responses of baboons after in vivo thrombin generation--effect of interleukin 6. 918 1

An animal model of gram-positive septicemia was developed to evaluate the effects of antithrombin (AT) concentrates on morbidity, mortality, and laboratory consequences of disseminated intravascular coagulation (DIC). DIC was induced in guinea pigs by infusing Staphylococcus aureus (SA) isolated from blood cultures of patients with DIC (DIC-SA) or without DIC (non-DIC-SA). The non-DIC-SA animals and animals infused with sterile saline served as controls. Varying doses of AT were administered either 30 minutes or 24 hours after infusion of SA. DIC was confirmed within 4 hours by changes in prothrombin time, activated partial thromboplastin time, fibrinogen, fibrinogen-fibrin degradation products, and AT activity. Clinical bleeding was also evident. Mortality of untreated DIC-SA animals was 36% within 24 hours and up to 75% by 72 hours. Intervention with any dose of AT between 125 and 1,000 IU/kg 30 minutes after DIC-SA infusion was associated with 100% survival (P < or = .05 in the 250 IU/kg group) and sustained increases in AT activity and fibrinogen concentrations (P < or = .05). When AT was administered in combination with low molecular weight heparin (LMWH) or if LMWH was adminstered alone, mortality from DIC-SA was slightly, but not significantly reduced compared with untreated DIC-SA. Gross hemorrhage was observed premortem and at autopsy in all of the DIC-SA animals but in substantially fewer animals that received AT (P < or = .001 in the 250, 500, and 1,000 IU/kg groups). In contrast, groups treated with LMWH, alone or with AT, experienced hemorrhage and appeared to develop pathologic DIC. Fibrin formation in end-organs was detected in all guinea pigs in the untreated DIC-SA group and in the groups treated with 125 IU/kg AT and LMWH alone. AT doses between 250 and 1,000 IU/kg administered 30 minutes after DIC-SA infusion prevented fibrin formation in end-organs (P < or = .001 in the 250 and 1,000 IU/kg groups). AT administered 24 hours after DIC-SA could not reverse pre-existing histopathologic evidence of DIC but favorably affected survival, which reached statistical significance in the 1,000 IU/kg AT group (P < or = .025). In summary, suprapharmacologic doses of AT concentrate significantly decreased morbidity and mortality and ameliorated adverse changes in laboratory measures induced by DIC-SA in this guinea pig model and were not associated with untoward hemorrhagic complications. These findings provide justification for studying the use of AT therapy in patients with DIC-SA.
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PMID:The suprapharmacologic dosing of antithrombin concentrate for Staphylococcus aureus-induced disseminated intravascular coagulation in guinea pigs: substantial reduction in mortality and morbidity. 919 63

Heparin-induced thrombocytopenia is an uncommon but potentially dangerous adverse effect of heparin therapy. Late onset thrombocytopenia is usually observed several days after initiating treatment and can be distinguished from early-onset benign thrombocytopenia which is more moderate and transitory and which results from a direct interaction between heparin and platelet membrane proteins which potentialize ADP-induced aggregation. Severe late-onset thrombocytopenia clearly results from an immunological mechanism due to the development of heparin-independent antiplatelet antibodies, often IgGs. These antibodies do not cause cell lysis but have a platelet-activating effect with release of the contents of the dense alpha granulations. This cell activation requires the formation of a heparin-dependent antibody-platelet complex. In most cases, platelet factor 4, an alpha granule protein, would be implicated. The antibody-platelet interaction has an activating effect following binding of the IgG Fc fragment to the Fc gamma RII receptor. The antibodies could also bind, favoring the development of thrombosis. The diagnosis of heparin-induced thrombocytopenia is evidenced by a platelet count under 100 Giga/l, usually from the 5th to 20th week of heparin therapy. Occasionally, the only sign is the low platelet count (drop of over 40% from pretreatment levels). Coagulation activation can lead to diffuse consumption coagulopathy in about 25% of the cases. Clinically, thrombosis is observed in about one half of the cases. Arterial thrombosis is the most characteristic and concerns the aorta and its branches as well as cerebral, coronary, mesenteric, renal and upper limb arteries. Venous thrombosis may be underestimated as they often occur as paradoxical recurrence after heparin therapy. Hemorrhage is much less frequent (less than 20% of cases) and often benign. To diagnose heparin-induced thrombocytopenia, one must eliminate other potential causes (infection, drug...), observe complete normalization of platelet count after heparin withdrawal, and demonstrate heparin-dependent antibodies in the plasma or serum. Different laboratory tests are quite helpful but have variable sensitivity. The incriminated heparin must be discontinued immediately. Use of low-molecular-weight heparins, even when cross-reactivity is not demonstrated in vitro, is not recommended. Other compound however, such as Orgaran 10,172 (or Lomoparan, appear to be the best choice. The action of antivitamin K agents is delayed and, due to the early dissociated drop in protein C at the beginning of treatment further raise the major risk of thrombosis. Classic antiplatelet agents such as aspirin are ineffective if used alone. More powerful compounds such as Ilomedine, are not available for this indication and are difficult to titrate. Part of the therapeutic problem with heparin-induced thrombocytopenia may be resolved with the advent of molecules with a direct antithrombin effect such as hirudine or its analogues. As suggested by a recent study, widespread use of low-molecular-weight heparin will undoubtedly have a highly significant effect on reducing the number of cases of severe thrombocytopenia.
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PMID:[Thrombopenia induced by heparin. From physiopathology to treatment]. 923 38

Antithrombin (AT) is a single-chain glycoprotein in plasma and belongs to the family of the serpins. It is synthesized in liver parenchymal cells, and its plasma concentration is between 112-140 mg/L. AT is a unique inhibitor of the clotting system and neutralizes most of the enzymes generated during activation of the clotting cascade, especially thrombin, factors Xa and IXa. Equimolar, irreversible complexes are formed between AT and the enzymes. The interaction between AT and the activated clotting factors is at least 1,000-fold increased in the presence of heparins. Heparins bind to multiple sites of the AT molecule resulting in a steric reconfiguration. Heparins contain a specific pentasaccharide unit which is the minimum requirement for AT binding. The glycosaminoglycan (GAG) heparan sulfate found on endothelial cell surfaces also contains this pentasaccharide and can thus "activate" AT. It is believed that much of the physiological inactivation of enzymes by AT occurs on the endothelium, mediated by heparan sulfate. The binding of AT to the GAGs also releases prostacyclin which possesses strong antiinflammatory properties. Deficiencies of AT are inherited or acquired. Only acquired defects due to increased consumption are discussed, most notably AT in DIC, especially DIC in sepsis. During acute DIC, clotting factors and inhibitors are consumed faster than they can be reproduced. This consumption of AT is of great significance in DIC and sepsis, and plasma AT levels predict outcome. AT levels drop early in sepsis and laboratory signs of DIC can already be found in patients with SIRS and early sepsis. The important role of AT in DIC and sepsis is the basis for considering antithrombin concentrates as an additional therapeutic modality.
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PMID:Antithrombin: its physiological importance and role in DIC. 951 76

Sepsis and its associated complications of disseminated intravascular coagulation (DIC) and multiple organ dysfunction syndrome (MODS) continue to be a major cause of morbidity and mortality. Improved detection of all forms of DIC is essential to assure earlier diagnosis. Studies already indicate that the therapeutic use of antithrombin (AT) concentrate may produce a more positive outcome for sepsis-associated DIC. If DIC could be identified earlier and AT concentrate could then be given earlier in the sepsis continuum, study results for the use of AT concentrate in humans might reveal a statistically significant difference versus placebo, and the efficacy of AT concentrate for this syndrome is more likely to be proved. Fixed-bolus doses of AT concentrate based on body weight are currently preferred, but improved, user-friendly assays for plasma AT levels would permit more rapid turnaround time for AT results and could help fine-tune the use of AT concentrate to the specific needs of each patient. Clinical trials involving the therapeutic use of AT concentrate in sepsis should continue, and it can be hoped that their design will reflect the concepts and conclusions offered by this panel of investigators.
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PMID:Therapeutic use of antithrombin concentrate in sepsis. 957 41

In a group of 993 patients with serious medical diseases an important deficiency of antithrombin III was found in patients with hepatic insufficiency, pulmonary embolism and with disseminated intravascular coagulation. Acquired antithrombin III deficiency in these conditions develops when the antithrombin production in the liver is low and also in patients with shock syndrome and disseminated intravascular coagulation. Assessment of antithrombin III is of diagnostic and prognostic value in thrombotic and prethrombotic conditions and its results is decisive for adequate substitution. Adequate AT III substitution without concurrent heparin administration in patients with septicaemia and manifestations of DIC improves the prognosis of patients with an increased endothelial resistance.
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PMID:[Antithrombin III in various conditions in internal medicine]. 960 77

Localized edema of the larynx and pharynx leading to death from asphyxia has long been recognized as a characteristic symptom of hereditary angioneurotic edema (HANE). Long-term follow-up of younger HANE patients has revealed that transient localized acute attacks of edema affect tissues where the microcirculation maintains the blood supply. However, with aging, HANE attacks precipitate disseminated intravascular coagulation (DIC) or multiple organ failure (MOF). Substitution with a C1-inhibitor (C1-INH) has resulted in a fulminant lethal end with a rapid and profound decrease in antithrombin-III (AT-III) activity. A possible mechanism is as follows: Exogenous stimuli activate plasma proteinase systems with the generation of plasma kallikrein that activates the tissue factor pathway (TF) and liberates bradykinin (BK). In younger patients, BK enhances vascular permeability. In the elderly, activated TF is controlled by tissue factor pathway inhibitor (TFPI) and generates thrombin, which is the target enzyme of AT-III and precipitates DIC or MOF. In elderly patients, the characteristic symptom of HANE is hypercoagulation by age-related changes in the biosynthesis of AT-III or TFPI.
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PMID:Hereditary angioneurotic edema and thromboembolic diseases: I: How symptoms of acute attacks change with aging. 965 97


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