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

Consumption coagulopathy resulting from arterial aneurysm is an uncommon entity. Two patients, one with a femoral artery aneurysm and one with an abdominal aortic aneurysm containing fresh blood clot associated with a coagulopathy are presented. Reasonable preoperative control of the bleeding disorder with appropriate blood products followed by aneurysmectomy is recommended. Except to treat severe bleeding disorders associated with arterial aneurysms, heparin therapy is rarely necessary, as spontaneous reversal of the coagulopathy usually occurs. A high index of suspicion for the presence of an underlying arterial aneurysm as the cause for the consumption coagulopathy is necessary when no other etiology is obvious.
J Cardiovasc Surg (Torino)
PMID:Consumption coagulopathy associated with arterial aneurysms. 44 64

Blood coagulation screening profiles were performed in 512 patients who underwent open-heart surgery with extracorporeal circulation. Severe coagulation disorders were found in 29 (5.6 per cent) patients. The most common abnormalities were low one-stage prothrombin time (PT) activities and impaired whole blood clot retractions. In the majority of patients the discrepancy between low PT's and normal or only slightly depressed factor II, V, VII, and X activities was explained by the presence of an inhibitor of the extrinsic system. Eight patients demonstrated the heparin rebound phenomenon but only 1 bled excessively. The pattern of severe hepatic dysfunction was found in 4 and severe depression of vitamin K-dependent factors due to oral anticoagulants in 2. Two had disseminated intravascular coagulation. Seventeen patients with normal coagulation screening profiles bled excessively postoperatively. Of these, 2 had moderate thrombocytopenia associated with a marked platelet functional abnormality. Revision of the wound in 13 revealed a surgical hemostatic defect and in 2 the cause of bleeding could not be determined.
J Thorac Cardiovasc Surg 1975 Jul
PMID:The hemostatic mechanism after open-heart surgery. I. Studies on plasma coagulation factors and fibrinolysis in 512 patients after extracorporeal circulation. 115 4

Recent improvements in total artificial heart (TAH) experiments have changed the pathological findings as well as the concept of the TAH. In the past 3 years, 67 experiments were performed in our laboratory. This study concerns the 11 calves operated upon most recently. Histopathological findings in the lungs, kidneys, livers and spleens of these animals were greatly improved over findings from previously studied animals. Disseminated intravascular coagulation (DIC) syndrome has been seen in only 1 calf. These improvements can be attributed to the following factors: (1) Improved management of the lumg during surgery has essentially eliminated pulmonary insufficiency;(2) liver damage has been successfully prevented by the discovery of the relationship between high right atrial pressure and anemia; (3) careful aseptic surgical procedures and optimal prophylactic use of antibiotics and anticoagulants have minimized the incidence of infection and clot formation.
J Thorac Cardiovasc Surg 1975 Aug
PMID:Refinement in application of total artificial heart, with improvement in survival and histopathological findings. 115 7

Twenty-eight patients were supported with long-term extracorporeal membrane oxygenation as a treatment for acute respiratory insufficiency. Clinical, laboratory, and autopsy data concerning platelets, hemostasis, and thromboembolic disease are presented for the periods during and after bypass. During bypass, a "foreign-surface coagulopathy" was encountered which consisted of abnormal bleeding plus frequent, generalized, small and large vessel thromboembolic events. The abnormal bleeding is attributed to heparin, thrombocytopenia, and a qualitative platelet defect. Possible causes of the thromboembolic events including disseminated intravascular coagulation are also discussed, and speculations are offered concerning clinical management and directions for future investigation.
J Thorac Cardiovasc Surg 1975 Oct
PMID:Platelets, hemostasis, and thromboembolism during treatment of acute respiratory insufficiency with extracorporeal membrane oxygenation. 117 77

Success of a perfusion depends not as much on the perfusion system as how that system is applied. A bubble oxygenator system properly managed can be safely run for many hours. Perfusion rate alone is an inadequate criteria for conduct of an adequate perfusion. 75 to 100 cc/kilo/min. perfusion rate is recommended. Minimal mean arterial pressures (60-70 mmHg) are essential to maintain good function of all organ systems for many hours of perfusion and to avoid disseminated intravascular coagulation by keeping capillary beds open. Foreign blood (bank blood) should be avoided to a maximal degree as foreign blood along with hypotensive situations as with poor perfusions can increase predisposition to DIC and organ failure. Hypokalemia (plasma and intracellular) predisposes to poor peripheral resistance during perfusion and consequent low mean arterial pressures. Fifty to 150 meq. of potassium chloride injected into the perfusate is generally required. Excessively high pO2 (over 150) and/or excessively low pCO2 (under 35) may contribute to CNS aberrations. Cannula placement and size are important considerations as well as suction forces on the venous cannula due to hydrostatic pressure on the venous return line. This force must be varied at times for maximal return. The inferior canal catheter must be kept out of the hepatic veins.
J Cardiovasc Surg (Torino)
PMID:What constitutes adequate perfusion? 119 30

Patients with shock lung syndrome were identified as those who developed acute respiratory failure after a profound episode of hypotension secondary to hemorrhagic, gram-negative, or endotoxic shock. In this study, each of the 10 patients with shock lung syndrome received methylprednisolone sodium succinate, 30 mg. per kilogram, intravenously every 6 hours for 48 hours. In addition, all patients were supported with mechanical ventilation, with or without positive end-expiratory pressure (PEEP). Arterial oxygenation improved markedly, and pulmonary edema resolved in all patients. Nine were discharged from the hospital and one died subsequently of disseminated intravascular coagulation. This study demonstrated a significant improvement in mortality rate with repeated pharmacologic doses of methylprednisolone compared to previously reported mortality rates of 60 to 90 per cent in patients with shock lung syndrome treated without repeated pharmacologic doses of steroid therapy.
J Thorac Cardiovasc Surg 1976 May
PMID:Methylprednisolone. Pharmacologic doses in shock lung syndrome. 126 66

As the ages of patients undergoing cardiac operations have increased, noncardiac causes of death have increased. To identify these causes of death, we analyzed the autopsy findings in 221 patients undergoing myocardial revascularization or valve operations between 1982 and 1989. Mean age was 65.6 +/- 9.5 years and the range was from 32 to 94 years; 130 patients (58.8%) were male. Autopsies were complete in 129 patients (58.4%) and limited to the chest and abdomen in the remainder. Embolic disease was identified in 69 patients (31.2%). Atheroemboli or abnormalities consistent with atheroemboli were identified in 48 patients (21.7%). Fourteen patients had thromboembolism and 7 had disseminated intravascular coagulation. The prevalence of atheroembolic disease increased dramatically from 4.5% in 1982 to 48.3% in 1989 (p = 0.001). Atheroembolic disease was found in the brain in 16.3% of patients, spleen in 10.9%, kidney in 10.4%, and pancreas in 6.8%. Thirty (62.5%) of the 48 patients had multiple atheroembolic sites. Atheroemboli were more common in patients undergoing coronary artery procedures (43/165; 26.1%) than in those undergoing valve procedures (5/56; 8.9%) (p = 0.008). There was a high correlation of atheroemboli with severe atherosclerosis of the ascending aorta. Atheroembolic events occurred in 46 of 123 patients (37.4%) with severe disease of the ascending aorta but in only 2 of 98 patients (2%) without significant ascending aortic disease (p less than 0.0001). Forty-six of 48 patients (95.8%) who had evidence of atheroemboli had severe atherosclerosis of the ascending aorta. There was a direct correlation between age, severe atherosclerosis of the ascending aorta, and atheroemboli. Incremental risk factors for atheroembolic are peripheral vascular disease and severe atherosclerosis of the ascending aorta.
J Thorac Cardiovasc Surg 1992 Jun
PMID:Atheroembolism from the ascending aorta. An emerging problem in cardiac surgery. 159 74

To examine the role of endothelin (ET) in the maternal and fetal circulation, the levels of endothelin-1-like immunoreactivity (ET-1-LI) in the plasma of maternal vein (MV), umbilical vein (UV), and umbilical artery (UA) were determined by a sensitive radioimmunoassay (RIA). Levels of ET-1-LI in MV did not show any significant change (9.9 +/- 1.5 pg/ml, n = 26) throughout normal pregnancy and were similar to those of normal nonpregnant women (10.7 +/- 2.5 pg/ml, n = 5). Levels of ET-1-LI in UV and UA obtained at normal deliveries at term were about three times higher than those in MV. In the patients with mild and severe pre-eclampsia, the levels of plasma ET-1-LI were significantly higher than those of normal pregnancy (14.3 +/- 2.2 pg/ml, n = 5 and 27.2 +/- 8.6 pg/ml, n = 5, respectively). However, in pregnant women with chronic hypertension, the levels of ET-1-LI did not increase when the hypertension did not worsen during pregnancy (11.4 +/- 1.6 pg/ml, n = 7). Moreover, in two pregnant women with abnormally stimulated coagulation, such as acute or subacute DIC, the levels of ET-1-LI were extremely high and returned gradually to those of normal nonpregnant women after the coagulation was normalized by treatment. These results suggest the possibility that ET-1 plays an important role in the pathophysiology of preeclampsia.
J Cardiovasc Pharmacol 1991
PMID:Concentrations of endothelin-1 in maternal and umbilical cord blood at various stages of pregnancy. 172 7

Activated leukocytes are thought to contribute to respiratory dysfunction, alterations in microvascular permeability, disseminated intravascular coagulation, and thrombosis, all of which can complicate extracorporeal circulation. The purpose of this work was to determine the effects of extracorporeal circulation on leukocyte functions likely to mediate organ damage. White blood cell counts in the bubble circuits (n = 5) fell to 51% +/- 7% (mean +/- standard error of the mean; p less than 0.05) of initial levels within 2 hours of recirculation. In contrast, counts from both the spiral coil (n = 5) and hollow-fiber (n = 5) groups remained at 91% +/- 12% and 100%, respectively. Plasma levels of human neutrophil elastase rose from 0.28 +/- 0.06 micrograms/ml to 3.14 +/- 0.36 micrograms/ml (p less than 0.05) and 0.20 +/- 0.02 micrograms/ml to 1.61 +/- 0.35 micrograms/ml (p less than 0.05) in bubble and spiral coil circuits, respectively, but from only 0.20 +/- 0.03 micrograms/ml to 0.96 +/- 0.42 micrograms/ml in the hollow-fiber circuit despite 2 hours of recirculation. Consistently, in response to N-formyl-L-methionyl-L-leucyl-L-phenylalanine, a chemotactic peptide, cells from spiral coil and bubble circuits released and generated significantly less elastase and superoxide anion, respectively. In contrast, neutrophils from the hollow-fiber circuits demonstrated enhancement of N-formyl-L-methionyl-L-leucyl-L-phenylalanine-induced elastase release and superoxide generation. Finally, mixed leukocytes from all circuits expressed procoagulant activity reaching statistical significance in bubble circuits. In conclusion, extracorporeal circulation has pronounced effects on neutrophil elastase release, superoxide anion generation, and leukocyte procoagulant activity. Spiral coil and bubble oxygenators cause granule release and, subsequently, reduced sensitivity to soluble agonists. In contrast, hollow-fiber oxygenators "prime" cells, actually enhancing reactivity. Recirculation through all circuits induces leukocyte procoagulant activity that is likely to contribute to surface-induced thromboses and excessive bleeding.
J Thorac Cardiovasc Surg 1991 Feb
PMID:Effects of simulated extracorporeal circulation on human leukocyte elastase release, superoxide generation, and procoagulant activity. 184 28

Reinfusion of mediastinal blood after coronary bypass grafting reduces the need for homologous transfusion with its hazards. To determine the efficacy of autotransfusion using the cardiotomy reservoir used during operation as a postoperative collection system, we studied the characteristics of reservoir blood (minimum 500 ml, mean 810 ml) and compared the hematologic profiles of 21 patients before and after blood infusion. The mean hematocrit value of the shed blood was 25% +/- 7%, platelet count 60,000 +/- 39,000/microliter, fibrinogen 19 +/- 25 mg/dl, and factor VIII 11% +/- 7%. The fibrinopeptide A concentration was 400 ng/ml, and the B beta 15-42 peptide was 28 +/- 14 pmol/ml. These values indicate defibrination of the blood before collection (no clots were found in the reservoirs), and no significant differences were detected between the types of reservoirs used (Bentley, n = 10, Shiley, n = 11). Infusion of reservoir blood between 500 and 1860 ml did not significantly affect the factor VIII, fibrinopeptide A, or B beta 15-42 peptide levels. Fibrinogen levels increased from 254 to 395 mg/dl (p less than 0.001). Only six of 21 patients received bank blood before discharge. These findings indicate that extensive coagulation occurs within the mediastinum before the blood is collected, that mediastinal blood can be safely infused without inducing fibrinolysis or disseminated intravascular coagulation, and that use of the cardiotomy reservoir is a safe and inexpensive method of autotransfusion after coronary artery bypass grafting.
J Thorac Cardiovasc Surg 1988 Jul
PMID:Autotransfusion after cardiac operation. Assessment of hemostatic factors. 326 Mar 14


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