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[Disseminated intravascular coagulations]

P Amstutz1, J S Moyo

  • 1Service de Réanimation, Hôpital Saint-Antoine, Paris.

Cahiers D'Anesthesiologie
|January 1, 1996
PubMed
Summary

Disseminated intravascular coagulation (DIC) involves microcirculation fibrin deposits and consumption coagulopathy. Treatment focuses on the underlying cause, with limited use for heparin and supportive transfusions for bleeding.

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Area of Science:

  • Hematology and Coagulation Disorders
  • Pathophysiology of Thrombosis and Hemorrhage

Context:

  • Disseminated intravascular coagulation (DIC) is a complex syndrome characterized by widespread fibrin deposition in the microcirculation.
  • It presents with a consumption coagulopathy, leading to diverse clinical manifestations from subtle to severe bleeding.
  • Understanding DIC pathophysiology has evolved, revealing non-occlusive fibrin deposits cleared by secondary fibrinolysis.

Purpose:

  • To define Disseminated intravascular coagulation (DIC) syndromes and their biological counterpart, consumption coagulopathy.
  • To review the clinical profiles, diagnostic tests, and pathophysiology of DIC.
  • To discuss current treatment strategies and emerging therapeutic approaches for DIC.

Summary:

  • DIC involves microcirculation fibrin deposits and consumption coagulopathy, with varied clinical presentations like purpura fulminans.
  • Diagnostic tools include standard coagulation tests, D-dimers, Antithrombin-III, protein C, and alpha 2-antiplasmin.
  • Treatment primarily addresses the underlying cause, with strict indications for heparin, and supportive measures like FPC and platelet transfusions for hemorrhage.

Impact:

  • Advances in understanding DIC pathophysiology clarify the role of fibrinolysis and its limited association with organ failure.
  • Prognosis in DIC is not directly correlated with coagulopathy severity, as seen in contrasting mortality rates between abruptio placentae and septic shock.
  • Ongoing research explores novel treatments, including antithrombin-III and C1-esterase inhibitors, for specific DIC complications.

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