Document Detail


Disseminated intravascular coagulation with a fibrinolytic phenotype at an early phase of trauma predicts mortality.
MedLine Citation:
PMID:  19660788     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Disseminated intravascular coagulation (DIC) with an antifibrinolytic phenotype is characterized by microvascular thrombosis leading to poor outcome at the late-stage of trauma. To test the hypothesis that DIC with a fibrinolytic phenotype at an early stage of trauma also contributes to a poor outcome due to severe bleeding, we conducted a retrospective, cohort study. MATERIALS AND METHODS: The subjects included 314 consecutive severe trauma patients. A systematic review of medical records of the patients was conducted to provide the base line characteristics and DIC-related variables. The data of these variables were obtained at 4 time points within 24 hr after arrival to the emergency department (ED); Time Point 1, immediately after arrival to the ED to 4 hr after arrival; Time Point 2, 4 to 8 hr after arrival; Time Point 3, 8 to 16 hr after arrival; Time Point 4, 16 to 24 hr after arrival. RESULTS: Nonsurvivors (87.3%, 48/55) met the Japanese Association for Acute Medicine (JAAM) DIC criteria showing lower fibrinogen levels, a prolonged prothrombin time, and higher fibrin/fibrinogen degradation products (FDP) and D-dimer levels in comparison to those of the 289 survivors. The FDP/D-dimer ratio and lactate level were significantly higher in the nonsurvivors than those of the survivors. Lower fibrinogen levels and higher FDP/D-dimer ratio suggest fibrinogenolysis in DIC of the nonsurvivors. Furthermore a stepwise logistic regression analysis showed that the JAAM DIC score, levels of fibrinogen, FDP and lactate at Time Point 1 are independent predictors of death. Low levels of fibrinogen and high FDP but not D-dimer predict massive bleeding at an early stage of trauma. The optimal cutoff points for the prediction of death and massive bleeding were fibrinogen (1.90, 1.90 g/L) and FDP (35.2, 68.7 mg/L), respectively. CONCLUSIONS: DIC with a fibrinolytic phenotype modified through fibrinogenolysis at an early phase of trauma contributes to poor prognosis due to massive bleeding. Tissue hypoperfusion may be involved in the pathogenesis of this type of DIC.
Authors:
Atsushi Sawamura; Mineji Hayakawa; Satoshi Gando; Nobuhiko Kubota; Masahiro Sugano; Takeshi Wada; Ken-ichi Katabami
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Publication Detail:
Type:  Journal Article; Review     Date:  2009-08-05
Journal Detail:
Title:  Thrombosis research     Volume:  124     ISSN:  1879-2472     ISO Abbreviation:  Thromb. Res.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-19     Completed Date:  2010-02-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0326377     Medline TA:  Thromb Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  608-13     Citation Subset:  IM    
Affiliation:
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Japan.
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MeSH Terms
Descriptor/Qualifier:
Adult
Blood Coagulation
Blood Platelets / physiology
Disseminated Intravascular Coagulation / blood*,  etiology
Female
Fibrinolysis
Humans
Male
Middle Aged
Phenotype
Prognosis
ROC Curve
Regression Analysis
Severity of Illness Index
Treatment Outcome
Wounds and Injuries / blood*
Comments/Corrections
Comment In:
Thromb Res. 2009 Dec;124(6):651-2   [PMID:  19931677 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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