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A clinicopathological study on cardiac lesions in 64 cases of disseminated intravascular coagulation
Insights
Disseminated intravascular coagulation (DIC) affects over 16% of autopsy cases, particularly the elderly, often complicated by cardiac lesions. Increased fibrin degradation products correlate with coronary thrombosis in DIC patients.
Area of Science:
- Pathology
- Cardiovascular Medicine
- Hematology
Background:
- Disseminated intravascular coagulation (DIC) is a complex syndrome with significant morbidity and mortality.
- Cardiac complications are frequently observed in patients with DIC, but their specific associations require further elucidation.
- Autopsy studies provide valuable insights into the pathological manifestations of DIC and its systemic impact.
Purpose of the Study:
- To investigate the incidence of DIC in autopsy cases.
- To determine the prevalence and types of cardiac lesions associated with DIC.
- To explore the relationship between laboratory markers, cardiac pathology, and DIC.
Main Methods:
- Retrospective autopsy study of 395 cases.
- Diagnosis of DIC based on established criteria.
- Systematic examination of cardiac structures for fresh lesions, thrombosis, and necrosis.
- Correlation analysis of laboratory parameters (platelet count, fibrinogen, euglobulin lysis time, fibrin degradation products) with cardiac findings.
Main Results:
- DIC was diagnosed in 16.2% of autopsy cases (64/395), with a mean age of 76.3 years.
- Fresh cardiac lesions were found in 62.5% of DIC cases, including coronary thrombosis (20.3%) and myocardial necrosis (37.5%).
- Elevated fibrin degradation products correlated with coronary thrombosis, irrespective of myocardial necrosis.
Conclusions:
- DIC is common in the elderly and frequently associated with acute cardiac pathology.
- Acute myocardial infarction in DIC may result from coronary artery stenosis or peripheral microthrombi.
- Fibrin degradation products serve as a potential indicator for coronary thrombosis in DIC.
Abstract:
Diagnosis of disseminated intravascular coagulation (DIC) was made in 64 cases (16.2%) among a total of 395 autopsy cases. There were 31 men and 33 women. Their ages ranged from 31 to 91 years (mean 76.3). Underlying diseases were mainly malignancy and sepsis. Fresh cardiac lesions were found in 40 cases (62.5%). Coronary thrombosis was found in 13 cases (20.3%) and myocardial necrosis in 24 cases (37.5%), with acute myocardial infarction in 9 and focal necrosis in 15. Nonbacterial thrombotic endocarditis was found in 17 cases (26.6%), mural thrombi in 11 (17.2%), and bleeding of the heart in 11 (17.2%). Platelet count, fibrinogen and euglobulin lysis time were not correlated with myocardial necrosis nor coronary thrombosis. Increase of fibrin degradation products correlated with the presence of coronary thrombosis with or without myocardial necrosis. DIC was found with a high incidence in the aged, and many of them were complicated with fresh cardiac lesions. Development of acute myocardial infarction depends on the small thrombi in the severe stenosis of the main coronary arteries or on the multiple microthrombi in the peripheral coronary branches.