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Published on: September 9, 2012
Disseminated intravascular coagulation and coagulation disorders
1Department of Medicine, University Hospital of Mannheim, Mannheim, Germany. carl-erik.dempfle@med.ma.uni-heidelberg.de
Insights
Disseminated intravascular coagulation (DIC) involves massive coagulation activation. Drotrecogin alpha (activated) improves survival in severe sepsis patients with or without DIC, unlike other treatments.
Area of Science:
- Hematology
- Critical Care Medicine
- Pathophysiology
Background:
- Disseminated intravascular coagulation (DIC) is a complex syndrome characterized by widespread coagulation activation and consumption of clotting factors.
- Clinical presentations include consumption coagulopathy, sepsis-induced purpura fulminans, and viral hemorrhagic fevers.
- Current diagnostic scoring systems lack specificity for differentiating asymptomatic DIC, consumption coagulopathy, and thrombotic syndromes.
Purpose of the Study:
- To provide an update on recent advancements in the diagnosis and treatment of disseminated intravascular coagulation (DIC).
- To review current understanding of DIC pathophysiology and clinical manifestations.
- To evaluate the efficacy of novel therapeutic agents in managing DIC and associated conditions.
Main Methods:
- Review of recent literature on disseminated intravascular coagulation (DIC) diagnosis and treatment.
- Analysis of clinical trial data for agents like drotrecogin alpha (activated), tifacogin, and antithrombin.
- Examination of laboratory findings and clinical syndromes associated with DIC, including sepsis-induced purpura fulminans and viral hemorrhagic fevers.
Main Results:
- Disseminated intravascular coagulation (DIC) is marked by laboratory evidence of intense coagulation activation and depleted procoagulant factors.
- Drotrecogin alpha (activated) demonstrated a mortality benefit in severe sepsis patients, irrespective of DIC status, and is indicated for sepsis-induced purpura fulminans.
- Factor V Leiden mutation may confer a survival advantage in severe sepsis, suggesting a potential benefit from enhanced coagulation activation in this context.
Conclusions:
- Drotrecogin alpha (activated) offers improved survival chances for severe sepsis patients, with or without disseminated intravascular coagulation (DIC).
- Antithrombin and tifacogin have not shown significant benefits in improving clinical outcomes for severe sepsis.
- Further research is needed to refine diagnostic criteria and therapeutic strategies for various DIC presentations.
Purpose Of Review:
An update on recent developments in diagnosis and treatment of disseminated intravascular coagulation.
Recent Findings:
Disseminated intravascular coagulation is defined as a typical disease condition with laboratory findings indicating massive coagulation activation and reduction in procoagulant capacity. Clinical syndromes associated with the condition are consumption coagulopathy, sepsis-induced purpura fulminans, and viral hemorrhagic fevers. Consumption coagulopathy is observed in patients with sepsis, aortic aneurysms, acute promyelocytic leukemia, and other disseminated malignancies. Sepsis-induced purpura fulminans is characterized by microvascular occlusion causing hemorrhagic necrosis of the skin and organ failure. Viral hemorrhagic fevers result in massively increased tissue factor production in monocytes and macrophages, inducing microvascular thrombosis and consumption of platelets and coagulation factors. Current scoring systems do not distinguish between patients with asymptomatic disseminated intravascular coagulation, consumption coagulopathy and thrombotic syndromes. Patients with sepsis may be identified by activated partial thromboplastin time waveform analysis performed as part of routine coagulation testing. Drotrecogin alpha (activated) reduces mortality in patients with severe sepsis with and without disseminated intravascular coagulation and has been used in patients with sepsis-induced purpura fulminans. Tifacogin does not reduce mortality in severe sepsis associated with impaired coagulation. Patients with heterozygous factor V Leiden mutation and severe sepsis showed a lower 28-day mortality than patients without this mutation, supporting the assumption that an enhanced level of coagulation activation may be beneficial in patients with severe sepsis.
Summary:
Whereas antithrombin and tifacogin failed to improve clinical outcome in severe sepsis, drotrecogin alpha (activated) increased the chances of survival of patients with severe sepsis with and without disseminated intravascular coagulation.
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