Disseminated intravascular coagulation in neurosurgical patients: diagnosis by new laboratory methods

Disseminated intravascular coagulation (DIC) constitutes a part of the multiple organ failure (MOF) syndrome seen with such disorders as trauma and sepsis. Early detection of increased coagulation and fibrinolytic activity is important. The dynamic changes in some markers for early detection of the activation of these cascade systems are presented in relation to two patients with brain trauma. The clinical status and the severity of the disease were assessed by an established scoring method (APACHE II). The coagulation activation was noted by the appearance of increased end products of the coagulation cascade, such as soluble fibrin, thrombin-antithrombin complex, and prothrombin fragment 1 + 2. Fibrinolytic activation and an increased secondary inhibition of fibrinolysis were detected by increased levels of D-dimer and plasminogen activator inhibitor-1. Leukocyte activation was indicated by a rise in elastase. The laboratory results normalized with clinical improvement. These new methods seem to detect DIC earlier than traditional methods and may also be of value for monitoring treatment.