Document Detail

Association between pulmonary microthromboembolism and coagulation variables in hypercoagulable states: an autopsy study.
MedLine Citation:
PMID:  10489665     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: This autopsy study was carried out to investigate the relationship between the number of pulmonary microthromboemboli and coagulation tests in patients with coagulation abnormalities. METHODOLOGY: Fifty-one patients in whom coagulation studies were performed within 2 days prior to death were studied. The coagulation tests included platelet counts, prothrombin times expressed as International Normalized Ratios (INR), activated partial thromboplastin times, fibrinogen concentrations, plasma fibrinogen/fibrin fragment E antigen levels, and plasma D-dimer levels. For microscopic analysis, five tissue blocks of the lung were taken from each subject and the number of pulmonary microthromboemboli per 20 cm2 of tissue sections was calculated. RESULTS: Thirty-six of the 51 patients had pulmonary microthromboembolism. International Normalized Ratios were higher than 1.7 in 12 of 36 embolic and in two of 15 non-embolic patients (33.3% of sensitivity and 86.7% of specificity). There was no significant difference in D-dimer levels between the two groups. Multiple regression analysis identified that INR was significantly related to the number of microthromboemboli (P = 0.042). CONCLUSIONS: D-dimer levels appear to be inappropriate as a single screening test for disseminated intravascular coagulation (DIC) in critically ill patients because the levels in these subjects are elevated irrespective of the presence of microthromboemboli. Because of the high specificity, INR could be a specific marker for microthromboemboli. The significant association between the number of microthromboemboli and INR might indicate the importance of the extrinsic pathway in the initiation of DIC.
Y Katsumura; K Ohtsubo
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Respirology (Carlton, Vic.)     Volume:  4     ISSN:  1323-7799     ISO Abbreviation:  Respirology     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-10-21     Completed Date:  1999-10-21     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9616368     Medline TA:  Respirology     Country:  AUSTRALIA    
Other Details:
Languages:  eng     Pagination:  239-43     Citation Subset:  IM    
Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Yokohama City, Japan.
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MeSH Terms
Aged, 80 and over
Blood Coagulation*
International Normalized Ratio
Middle Aged
Pulmonary Embolism / physiopathology*
Thrombophilia / physiopathology*

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