RSS-Feed abonnieren
DOI: 10.1055/s-2001-18864
Disseminated Intravascular Coagulation in Trauma Patients
Publikationsverlauf
Publikationsdatum:
06. Dezember 2001 (online)
![](https://www.thieme-connect.de/media/sth/200106/lookinside/thumbnails/10.1055-s-2001-18864-1.jpg)
ABSTRACT
Disseminated intravascular coagulation (DIC) is characterized by the in vivo activation of the coagulation system, which results in the intravascular deposition of fibrin and consumption bleeding. DIC is a serious hemostatic complication of trauma. It can be clearly distinguished from physiological hemostatic response to trauma by using sensitive coagulofibrinolytic molecular markers. Physiological hemostasis to injuries is similar in all kinds of trauma without exception. There is an increase in circulating proinflammatory cytokines in DIC patients after trauma. Elevated cytokines induce tissue factor-mediated activation of coagulation, suppression of the anticoagulant pathway, and plasminogen activator inhibitor-1 (PAI-1)-mediated inhibition of fibrinolysis followed by disseminated fibrin deposition in the microvasculature. In addition to the occlusive microvascular thrombosis and hypoxia, sustained systemic inflammatory response characterized by neutrophil activation and endothelial damage plays a pivotal role in the development of multiple organ dysfunction syndrome (MODS) in posttrauma DIC patients. DIC associated with sustained systemic inflammatory response syndrome (SIRS) after trauma leads to the development of MODS, which is the main determinant of patients' outcome after trauma.
KEYWORD
Disseminated intravascular coagulation (DIC) - trauma - multiple organ dysfunction syndrome (MODS) - systemic inflammatory response syndrome (SIRS) - inflammation
REFERENCES
- 1 Levi M, de Jonge E, van der Poll T, ten Cate H. Disseminated intravascular coagulation. Thromb Haemost . 1999; 82 695-705
- 2 Cicala C, Cirino G. Linkage between inflammation and coagulation: An update on the molecular basis of the crosstalk. Life Sci . 1998; 62 1817-1824
- 3 Members of American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med . 1992; 20 864-874
- 4 Gando S, Tedo I, Kubota M. Posttrauma coagulation and fibrinolysis. Crit Care Med . 1992; 20 594-600
- 5 Gando S, Nakanishi Y, Tedo I. Cytokines and plasminogen activator inhibitor-1 in posttrauma disseminated intravascular coagulation: Relationship to multiple organ dysfunction syndrome. Crit Care Med . 1995; 23 1835-1842
- 6 Seyfer A E, Seaber A V, Dombrose F A, Urbaniak J R. Coagulation changes in elective surgery and trauma. Ann Surg . 1981; 193 210-213
- 7 Kluft C, Verheijen J H, Jie A FH. The postoperative fibrinolytic shutdown: A rapidly reverting acute phase pattern for the fast-acting inhibitor of tissue-type plasminogen activator after trauma. Scand J Clin Lab Invest . 1985; 45 605-610
- 8 Kapsch D N, Metzler M, Harrington M. Fibrinolytic response to trauma. Surgery . 1984; 95 473-478
- 9 Risberg B, Medegård A, Heideman M. Early activation of humoral proteolytic systems in patients with multiple trauma. Crit Care Med . 1986; 14 917-925
- 10 Goodnight S H, Kenoyer G, Rapaport S I. Defibrination after brain-tissue destruction. A serious complication of head injury. N Engl J Med . 1974; 290 1043-1047
- 11 Disseminated intravascular coagulation and head injury. Lancet (Editorial) . 1982; 2 531
- 12 >Abnormal blood clotting after head injury. Lancet (Review) . 1989; 2 957-958
- 13 Gando S, Nanzaki S, Kemmotsu O. Coagulofibrinolytic changes after isolated head injury are not different from those in trauma patients without head injury. J Trauma . 1999; 46 1070-1077
- 14 Levi M, ten Cate H, van der Poll T, van Deventer J H S. Pathogenesis of disseminated intravascular coagulation in sepsis. JAMA . 1993; 270 975-979
- 15 Gando S, Nanzaki S, Morimoto Y. Tissue factor pathway inhibitor response does not correlate with tissue-factor induced DIC and MODS in trauma patients. Crit Care Med . 2001; 24 262-266
- 16 Gando S. Serial studies of protein C in trauma patients. Jpn J Thromb Hemost [in Japanese] . 1996; 7 312-318
- 17 Owings J T, Gosselin R. Acquired antithrombin deficiency following severe traumatic injury: Rationale for study of antithrombin supplementation. Semin Thromb Hemost . 1997; 23(Suppl 1) 17-24
- 18 Gando S, Nakanishi Y, Kameue T, Nanzaki S. Soluble thrombomodulin increases in patients with disseminated intravascular coagulation and in those with multiple organ dysfunction syndrome after trauma: Role of neutrophil elastase. J Trauma . 1995; 39 660-664
- 19 Donnelly S C, Robertson C R. Mediators, mechanisms and mortality in major trauma. Resuscitation . 1994; 28 87-92
- 20 Moor F A, Sauaia A, Moor E E. Postinjury multiple organ failure: A bimodal phenomenon. J Trauma . 1996; 40 501-512
- 21 Yao Y M, Redl H, Bahrami S, Schlag G. The inflammatory basis of trauma/shock-associated multiple organ failure. Inflamm Res . 1998; 47 201-210
- 22 Penner J A. Disseminated intravascular coagulation in patients with multiple organ failure of non-septic origin. Semin Thromb Hemost . 1998; 24 45-52
- 23 Gando S, Kameue T, Nanzaki S. Increased neutrophil elastase, persistent intravascular coagulation, and decreased fibrinolytic activity in patients with posttraumatic acute respiratory distress syndrome. J Trauma . 1997; 42 1068-1072
- 24 Gando S, Nanzaki S, Morimoto Y. Systemic activation of tissue-factor dependent coagulation pathway in evolving acute respiratory distress syndrome in patients with trauma and sepsis. J Trauma . 1999; 47 719-723
- 25 Taylor F B, Chang A CK, Peer G T. DEGR-Factor Xa blocks disseminated intravascular coagulation initiated by Escherichia coli without preventing shock or organ damage. Blood . 1991; 78 364-368
- 26 Taylor F B, Stearns-Kurosawa J, Ferrell G. The endothelial cell protein C receptor aids in host defense against Echerichia coli sepsis. Blood . 2000; 95 1680-1686
- 27 Cirino G, Cicala C, Bucci M. Factor Xa as an interface between coagulation and inflammation. J Clin Invest . 1997; 99 2446-2451
- 28 Nast-Kolb D, Waydhas C, Gippner-Steppert C. Indicator of the posttraumatic inflammatory response correlate with organ failure in patients with multiple injuries. J Trauma . 1997; 42 446-455
- 29 Gando S, Kameue T, Nanzaki S. Participation of tissue factor and thrombin in posttraumatic systemic inflammatory syndrome. Crit Care Med . 1997; 25 1820-1826
- 30 Gando S, Nanzaki S, Kemmotsu O. Disseminated intravascular coagulation and sustained systemic inflammatory response syndrome predict organ dysfunctions after trauma. Application of clinical decision analysis. Ann Surg . 1999; 229 121-127