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.

Outcome of Disseminated Intravascular Coagulation in Relation to the Score when Treatment was Begun

1995 ◽  
Vol 74 (03) ◽  
pp. 848-852 ◽  
Author(s):  
Hideo Wada ◽  
Yoshihiro Wakita ◽  
Tutomu Nakase ◽  
Minori Shimura ◽  
Katsuyo Hiyoyama ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Plasma Levels ◽  
Early Stage ◽  
Coagulation Factors ◽  
Underlying Disease ◽  
Blood Coagulation Factors ◽  
Intravascular Coagulation ◽  
The Relationship ◽  
Plasmin Inhibitor ◽  
D Dimer

SummaryWe examined 395 patients with disseminated intravascular coagulation (DIC) divided into two groups: non-leukemic and leukemic. In 58% of the patients as a whole, treatment of DIC resulted in complete or partial remission, while exacerbation and death occurred in 31%. The efficacy of DIC treatment in the non-leukemic group was less than that in the leukemic group, indicating that the outcome of DIC depended, in part, on the underlying disease. We examined hemostatic indicators in relation to DIC score: prothrombin time (PT) ratio, FDP, platelet count, and fibrinogen levels were found to be important indicators for the diagnosis of DIC, but not for Pre-DIC. Plasma levels of fibrin-D-dimer, thrombin-antithrombin complex (TAT), and plasmin- plasmin inhibitor complex (PPIC) were significantly increased in pre-DIC. The efficacy of treatment in relation to the DIC score when the treatment was begun showed that greater efficacy was achieved in pre-DIC than in DIC patients. The outcome was poorer with increasing DIC score, suggesting that early diagnosis and early treatment are important. On examining the relationship between outcome and hemostatic indicators, we found that the PT ratio and the levels of antithrombin, plasminogen, PPIC, the PPIC/TAT ratio, and thrombomodulin were related to outcome, suggesting that very high consumption of blood coagulation factors, liver dysfunction, hypofibrinolysis, or organ failure caused a poor outcome. Although the outcome in DIC patients may not depend substantially on plasma levels of TAT and fibrin-D- dimer, we can use these indicators to treat DIC patients at an early stage.

scholarly journals The value of the portable fibrinogen measuring device—a case report of severe postpartum hemorrhage with obstetric disseminated intravascular coagulation

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yoko Hikida ◽  
Hiroyuki Sumikura ◽  
Hisako Okada ◽  
Takashi Fujino ◽  
Mayumi Tanaka ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Postpartum Hemorrhage ◽  
Point Of Care ◽  
Fresh Frozen Plasma ◽  
Fibrinogen Concentration ◽  
Important Indicator ◽  
Measuring Device ◽  
Intravascular Coagulation ◽  
Estimated Blood Loss ◽  
Care Assessment

Abstract Background Fibrinogen concentration is an important indicator of the treatment for obstetric disseminated intravascular coagulation (DIC). We present how using the fibrinogen measuring device could solve problems in the treatment of postpartum hemorrhage with complicated DIC. Case presentation A 32-year-old woman with monochorionic diamniotic twins at 22 weeks of pregnancy was diagnosed with placental abruption and underwent emergent cesarean section. The estimated blood loss was 8375 g. She was transferred to our hospital for further treatment. Compressive uterine sutures and balloon tamponade were performed. We transfused fibrinogen and fresh frozen plasma actively during the operation to maintain plasma fibrinogen above 200 mg/dL by using a point-of-care fibrinogen measuring device. In spite of massive hemorrhage exceeding 10 L, she was extubated at the end of the operation and discharged on the 7th day after the operation. Conclusion The portable fibrinogen measuring device was useful for point-of-care assessment of obstetric DIC.

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 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.

scholarly journals Diagnosis and management of disseminated intravascular coagulation: the role of heparin therapy

Blood ◽  
1982 ◽  
Vol 60 (2) ◽  
pp. 284-287 ◽  
Author(s):  
DI Feinstein
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Purpura Fulminans ◽  
Underlying Disease ◽  
Additional Treatment ◽  
Neoplastic Disease ◽  
Excessive Bleeding ◽  
Intravascular Coagulation ◽  
At Iii ◽  
Hemostatic Factors

Abstract Disseminated intravascular coagulation (DIC) is caused by a variety of underlying disorders, and criteria for diagnosis are not well defined. However, the most helpful are a low platelet count, positive plasma protamine test, and fibrinogen and fibrin degradation product levels viewed in the context of the patient's underlying disease. The cornerstone of therapy is prompt treatment of the underlying disease and elimination of the trigger mechanism. Additional treatment must be individualized, and generalizations are difficult to make. However, if the patient has low hemostatic factors and is actively bleeding or requires an invasive procedure, then replacement with the appropriate hemostatic factors should be tried. Heparin is indicated in patients with purpura fulminans and venous thromboembolism, but there is little evidence that heparin reverses organ dysfunction associated with DIC. In addition, heparin is also probably indicated in patients with retained dead fetus and hypofibrinogenemia prior to induction of labor, excessive bleeding associated with a giant hemangioma, and neoplastic disease, particularly promyelocytic leukemia. Although the use of heparin in acute forms of DIC remains controversial, the majority of studies suggest that it is not helpful. The role of antithrombin III (AT-III) concentrates is unknown, but they theoretically may be helpful when DIC is associated with very low AT-III levels, as is seen in liver disease.

Dipyridamole and Low Doses of Heparin as a New Successful Physiopathologic and Therapeutic Approach in 2 Cases of Disseminated Intravascular Coagulation

2010 ◽  
Vol 13 (1) ◽  
pp. 49 ◽  
Author(s):  
Otoni M. Gomes ◽  
Eros S. Gomes
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Clinical Condition ◽  
Clinical Signs ◽  
Young Patients ◽  
Acute Ischemia ◽  
Low Doses ◽  
Intravascular Coagulation ◽  
Good Clinical Condition ◽  
High Doses ◽  
General Care

Operative: We report 2 cases of disseminated intravascular coagulation (DIC) successfully treated with the combination of the platelet adhesiveness blocker dipyridamole and low doses of intravenous heparin.Methods: The first patient was a 17-year-old boy with septic arthritis; the second patient was a 12-year-old boy with a liver abscess. Both had hemocultures positive for Staphylococcus aureus. The diagnosis of DIC was defined by clinical signs of septicemia with fever, tachypnea, peripheral vasoconstriction, and low platelet counts (67,000/mm3 and 47,000/mm3, respectively). The second patient also presented with acute ischemia of the fingers and toes. General care was provided in the intensive care unit, and high doses of antibiotics were provided continuously (metronidazole and oxacillin or ceftriaxone). A 5% glucose solution containing dipyridamole (Persantine; Istituto De Angeli/Boheringer Ingelheim, Reggello, Italy) was administered by continuous intravenous infusion (20 mg/24 hours). In addition, regular heparin (Liquemin; Roche, Indianapolis, IN, USA) was administered at a dosage of 250 mg/kg per hour or 25 IU/kg per hour (6 mg/kg per 24 hours). These heparin doses are not able to promote complete blood anticoagulation. Treatment with heparin and dipyridamole was maintained for 10 days in the first patient and for 18 days in the second.Results: By 48 hours after treatment with dipyridamole and low-dose heparin, both patients recovered and presented with a good clinical condition and increased numbers of circulating platelets. Both patients were discharged in a safe clinical condition in the second month after hospital admission.Conclusion: Successful clinical recovery of 2 young patients with DIC with an unfavorable clinical evolution and a prognosis for a lethal outcome was achieved with the combination of a continuous infusion of dipyridamole and low doses of heparin.

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