Coagulation and fibrinolysis balance in disseminated intravascular coagulation.

Abstract

BACKGROUND:

Sepsis is a common underlying disease associated with disseminated intravascular coagulation (DIC). We have recently determined hemostatic pathological states at diagnosis through simultaneous assessment of coagulation and fibrinolysis potentials in sepsis-associated DIC using clot-fibrinolysis waveform analysis. Here we aimed to investigate hemostatic pathological states, focusing on the balance between coagulation and fibrinolysis dynamics during the clinical course in pediatric sepsis-associated DIC.

METHODS:

Coagulation and fibrinolysis potential functions in three pediatric patients with sepsis-associated DIC during their clinical course were quantified using clot-fibrinolysis waveform analysis. A maximum coagulation velocity (|min1|) and maximum fibrinolysis velocity (|FL-min1|) was calculated as a ratio relative to normal plasma.

RESULTS:

In case 1, coagulation-enhanced and fibrinolysis-depressed state (|min1|-ratio 2.22 and |FL-min1|-ratio 0.42) was observed on day 1. This discrepancy significantly reduced after anticoagulant therapy and plasma exchange on day 2. A well-balanced hemostatic state (0.70 and 0.62, respectively) was restored on day 7. In case 2, fibrinolysis-impaired state (|min1|-ratio 1.09 and |FL-min1|-ratio 0.21) was seen on day 1. The |min1| ratio was slightly prolonged and the |FL-min1| ratio was severely decreased. Both were restored on day 7 and returned to normal levels on day 12. In case 3, twofold coagulation- and fibrinolysis-enhanced states (|min1|-ratio 1.99 and |FL-min1|-ratio 1.11) were seen on day 1. However, both potentials rapidly decreased on day 2 (0.49 and 0.0, respectively). She died on day 5.

CONCLUSIONS:

The hemostatic pathological states in sepsis-associated DIC depend on disease progression. Comprehensive assessment of coagulation-fibrinolysis potentials over time may therefore be helpful in considering optimal treatment plans for sepsis-associated DIC.

• Authors: Tomoko Onishi, Takashi Ishihara, Keiji Nogami
• Journal: Pediatrics international : official journal of the Japan Pediatric Society (Pediatr Int) Vol. 63 Issue 11 Pg. 1311-1318 (Nov 2021) ISSN: 1442-200X [Electronic] Australia
• PMID: 33660897 (Publication Type: Journal Article)
• Copyright: © 2021 Japan Pediatric Society.

Topics

• Blood Coagulation
• Child
• Disseminated Intravascular Coagulation (diagnosis, etiology)
• Female
• Fibrinolysis
• Hemostasis
• Humans
• Sepsis