Disseminated intravascular coagulation classification: Difference between revisions
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==Overview== | ==Overview== | ||
[[Disseminated intravascular coagulation]] may be classified according to the degree of fibrinolytic activation into suppressed-fibrinolytic-type DIC (DIC with suppressed fibrinolysis), enhanced-fibrinolytic-type DIC (DIC with enhanced [[fibrinolysis]]) and balanced-fibrinolytic-type DIC (DIC with balanced [[fibrinolysis]]). Each type differs in clinical features and laboratory findings. | |||
==Classification== | ==Classification== | ||
Disseminated intravascular coagulation may be classified according to the degree of fibrinolytic activation into the following | [[Disseminated intravascular coagulation]] may be classified according to the degree of fibrinolytic activation into the following subtypes/groups<ref name="pmid25520834">{{cite journal |vauthors=Asakura H |title=Classifying types of disseminated intravascular coagulation: clinical and animal models |journal=J Intensive Care |volume=2 |issue=1 |pages=20 |date=2014 |pmid=25520834 |pmc=4267600 |doi=10.1186/2052-0492-2-20 |url=}}</ref>: | ||
=== Suppressed-fibrinolytic-type DIC (DIC with suppressed fibrinolysis) <ref name="pmid11395595">{{cite journal |vauthors=Asakura H, Ontachi Y, Mizutani T, Kato M, Saito M, Kumabashiri I, Morishita E, Yamazaki M, Aoshima K, Nakao S |title=An enhanced fibrinolysis prevents the development of multiple organ failure in disseminated intravascular coagulation in spite of much activation of blood coagulation |journal=Crit. Care Med. |volume=29 |issue=6 |pages=1164–8 |date=June 2001 |pmid=11395595 |doi= |url=}}</ref><ref name="pmid1689102">{{cite journal |vauthors=Takahashi H, Tatewaki W, Wada K, Hanano M, Shibata A |title=Thrombin vs. plasmin generation in disseminated intravascular coagulation associated with various underlying disorders |journal=Am. J. Hematol. |volume=33 |issue=2 |pages=90–5 |date=February 1990 |pmid=1689102 |doi= |url=}}</ref><ref name="pmid7865691">{{cite journal |vauthors=Asakura H, Jokaji H, Saito M, Uotani C, Kumabashiri I, Morishita E, Yamazaki M, Aoshima K, Matsuda T |title=Study of the balance between coagulation and fibrinolysis in disseminated intravascular coagulation using molecular markers |journal=Blood Coagul. Fibrinolysis |volume=5 |issue=5 |pages=829–32 |date=October 1994 |pmid=7865691 |doi= |url=}}</ref><ref name="pmid1899963">{{cite journal |vauthors=Asakura H, Jokaji H, Saito M, Uotani C, Kumabashiri I, Morishita E, Yamazaki M, Matsuda T |title=Changes in plasma levels of tissue-plasminogen activator/inhibitor complex and active plasminogen activator inhibitor in patients with disseminated intravascular coagulation |journal=Am. J. Hematol. |volume=36 |issue=3 |pages=176–83 |date=March 1991 |pmid=1899963 |doi= |url=}}</ref> === | === Suppressed-fibrinolytic-type DIC (DIC with suppressed fibrinolysis) <ref name="pmid11395595">{{cite journal |vauthors=Asakura H, Ontachi Y, Mizutani T, Kato M, Saito M, Kumabashiri I, Morishita E, Yamazaki M, Aoshima K, Nakao S |title=An enhanced fibrinolysis prevents the development of multiple organ failure in disseminated intravascular coagulation in spite of much activation of blood coagulation |journal=Crit. Care Med. |volume=29 |issue=6 |pages=1164–8 |date=June 2001 |pmid=11395595 |doi= |url=}}</ref><ref name="pmid1689102">{{cite journal |vauthors=Takahashi H, Tatewaki W, Wada K, Hanano M, Shibata A |title=Thrombin vs. plasmin generation in disseminated intravascular coagulation associated with various underlying disorders |journal=Am. J. Hematol. |volume=33 |issue=2 |pages=90–5 |date=February 1990 |pmid=1689102 |doi= |url=}}</ref><ref name="pmid7865691">{{cite journal |vauthors=Asakura H, Jokaji H, Saito M, Uotani C, Kumabashiri I, Morishita E, Yamazaki M, Aoshima K, Matsuda T |title=Study of the balance between coagulation and fibrinolysis in disseminated intravascular coagulation using molecular markers |journal=Blood Coagul. Fibrinolysis |volume=5 |issue=5 |pages=829–32 |date=October 1994 |pmid=7865691 |doi= |url=}}</ref><ref name="pmid1899963">{{cite journal |vauthors=Asakura H, Jokaji H, Saito M, Uotani C, Kumabashiri I, Morishita E, Yamazaki M, Matsuda T |title=Changes in plasma levels of tissue-plasminogen activator/inhibitor complex and active plasminogen activator inhibitor in patients with disseminated intravascular coagulation |journal=Am. J. Hematol. |volume=36 |issue=3 |pages=176–83 |date=March 1991 |pmid=1899963 |doi= |url=}}</ref> === | ||
* Severe coagulation activation | * Severe [[coagulation]] activation | ||
* Mild fibrinolytic activation | * Mild [[fibrinolytic]] activation | ||
* Seen in sepsis mostly | * Seen in [[sepsis]] mostly | ||
* Mild bleeding complications | * Mild [[bleeding]] complications | ||
* Elevated thrombin-antithrombin complex (TAT) , a coagulation activation marker | * Elevated thrombin-antithrombin complex (TAT) , a [[coagulation]] activation marker | ||
* Mildy elevated plasmin-α2 plasmin inhibitor complex (PIC), a fibrinolysis activation marker | * Mildy elevated plasmin-α2 plasmin inhibitor complex (PIC), a fibrinolysis activation marker | ||
* Mildly elevated Fibrin/fibrinogen degradation products (FDPs) and D-dimers | * Mildly elevated Fibrin/fibrinogen degradation products (FDPs) and D-dimers | ||
* Normal or only slightly decreased α2 plasmin inhibitor (α2PI) | * Normal or only slightly decreased α2 plasmin inhibitor (α2PI) | ||
=== Enhanced-fibrinolytic-type DIC (DIC with enhanced fibrinolysis)<ref name="pmid11395595">{{cite journal |vauthors=Asakura H, Ontachi Y, Mizutani T, Kato M, Saito M, Kumabashiri I, Morishita E, Yamazaki M, Aoshima K, Nakao S |title=An enhanced fibrinolysis prevents the development of multiple organ failure in disseminated intravascular coagulation in spite of much activation of blood coagulation |journal=Crit. Care Med. |volume=29 |issue=6 |pages=1164–8 |date=June 2001 |pmid=11395595 |doi= |url=}}</ref><ref name="pmid1689102">{{cite journal |vauthors=Takahashi H, Tatewaki W, Wada K, Hanano M, Shibata A |title=Thrombin vs. plasmin generation in disseminated intravascular coagulation associated with various underlying disorders |journal=Am. J. Hematol. |volume=33 |issue=2 |pages=90–5 |date=February 1990 |pmid=1689102 |doi= |url=}}</ref><ref name="pmid7865691">{{cite journal |vauthors=Asakura H, Jokaji H, Saito M, Uotani C, Kumabashiri I, Morishita E, Yamazaki M, Aoshima K, Matsuda T |title=Study of the balance between coagulation and fibrinolysis in disseminated intravascular coagulation using molecular markers |journal=Blood Coagul. Fibrinolysis |volume=5 |issue=5 |pages=829–32 |date=October 1994 |pmid=7865691 |doi= |url=}}</ref><ref name="pmid1899963">{{cite journal |vauthors=Asakura H, Jokaji H, Saito M, Uotani C, Kumabashiri I, Morishita E, Yamazaki M, Matsuda T |title=Changes in plasma levels of tissue-plasminogen activator/inhibitor complex and active plasminogen activator inhibitor in patients with disseminated intravascular coagulation |journal=Am. J. Hematol. |volume=36 |issue=3 |pages=176–83 |date=March 1991 |pmid=1899963 |doi= |url=}}</ref> === | |||
* Presents with marked [[fibrinolysis]] activation corresponding to [[coagulation]] activation | |||
* Strong activation of [[fibrinolysis]] | |||
* With hardly any elevation in PAI | |||
* Severe [[bleeding]] severe. | |||
* Elevation in both TAT and PIC | |||
* Elevated FDPs and D-dimer | |||
* FDP/D-dimer ratio tends to increase (decrease when expressed as the D-dimer/FDP ratio). | |||
* Associated with APL, abdominal [[aortic aneurysm]], and [[prostate cancer]] | |||
=== Balanced-fibrinolytic-type DIC (DIC with balanced fibrinolysis) <ref name="pmid11395595">{{cite journal |vauthors=Asakura H, Ontachi Y, Mizutani T, Kato M, Saito M, Kumabashiri I, Morishita E, Yamazaki M, Aoshima K, Nakao S |title=An enhanced fibrinolysis prevents the development of multiple organ failure in disseminated intravascular coagulation in spite of much activation of blood coagulation |journal=Crit. Care Med. |volume=29 |issue=6 |pages=1164–8 |date=June 2001 |pmid=11395595 |doi= |url=}}</ref><ref name="pmid1689102">{{cite journal |vauthors=Takahashi H, Tatewaki W, Wada K, Hanano M, Shibata A |title=Thrombin vs. plasmin generation in disseminated intravascular coagulation associated with various underlying disorders |journal=Am. J. Hematol. |volume=33 |issue=2 |pages=90–5 |date=February 1990 |pmid=1689102 |doi= |url=}}</ref><ref name="pmid7865691">{{cite journal |vauthors=Asakura H, Jokaji H, Saito M, Uotani C, Kumabashiri I, Morishita E, Yamazaki M, Aoshima K, Matsuda T |title=Study of the balance between coagulation and fibrinolysis in disseminated intravascular coagulation using molecular markers |journal=Blood Coagul. Fibrinolysis |volume=5 |issue=5 |pages=829–32 |date=October 1994 |pmid=7865691 |doi= |url=}}</ref><ref name="pmid1899963">{{cite journal |vauthors=Asakura H, Jokaji H, Saito M, Uotani C, Kumabashiri I, Morishita E, Yamazaki M, Matsuda T |title=Changes in plasma levels of tissue-plasminogen activator/inhibitor complex and active plasminogen activator inhibitor in patients with disseminated intravascular coagulation |journal=Am. J. Hematol. |volume=36 |issue=3 |pages=176–83 |date=March 1991 |pmid=1899963 |doi= |url=}}</ref>=== | |||
* Presents a balance between [[coagulation]] activation and [[fibrinolytic]] activation | |||
* Relatively uncommon [[bleeding]] and organ symptoms | |||
* Seen in solid cancers | |||
==References== | ==References== | ||
Latest revision as of 17:29, 22 August 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2]
Overview
Disseminated intravascular coagulation may be classified according to the degree of fibrinolytic activation into suppressed-fibrinolytic-type DIC (DIC with suppressed fibrinolysis), enhanced-fibrinolytic-type DIC (DIC with enhanced fibrinolysis) and balanced-fibrinolytic-type DIC (DIC with balanced fibrinolysis). Each type differs in clinical features and laboratory findings.
Classification
Disseminated intravascular coagulation may be classified according to the degree of fibrinolytic activation into the following subtypes/groups[1]:
Suppressed-fibrinolytic-type DIC (DIC with suppressed fibrinolysis) [2][3][4][5]
- Severe coagulation activation
- Mild fibrinolytic activation
- Seen in sepsis mostly
- Mild bleeding complications
- Elevated thrombin-antithrombin complex (TAT) , a coagulation activation marker
- Mildy elevated plasmin-α2 plasmin inhibitor complex (PIC), a fibrinolysis activation marker
- Mildly elevated Fibrin/fibrinogen degradation products (FDPs) and D-dimers
- Normal or only slightly decreased α2 plasmin inhibitor (α2PI)
Enhanced-fibrinolytic-type DIC (DIC with enhanced fibrinolysis)[2][3][4][5]
- Presents with marked fibrinolysis activation corresponding to coagulation activation
- Strong activation of fibrinolysis
- With hardly any elevation in PAI
- Severe bleeding severe.
- Elevation in both TAT and PIC
- Elevated FDPs and D-dimer
- FDP/D-dimer ratio tends to increase (decrease when expressed as the D-dimer/FDP ratio).
- Associated with APL, abdominal aortic aneurysm, and prostate cancer
Balanced-fibrinolytic-type DIC (DIC with balanced fibrinolysis) [2][3][4][5]
- Presents a balance between coagulation activation and fibrinolytic activation
- Relatively uncommon bleeding and organ symptoms
- Seen in solid cancers
References
- ↑ Asakura H (2014). "Classifying types of disseminated intravascular coagulation: clinical and animal models". J Intensive Care. 2 (1): 20. doi:10.1186/2052-0492-2-20. PMC 4267600. PMID 25520834.
- ↑ 2.0 2.1 2.2 Asakura H, Ontachi Y, Mizutani T, Kato M, Saito M, Kumabashiri I, Morishita E, Yamazaki M, Aoshima K, Nakao S (June 2001). "An enhanced fibrinolysis prevents the development of multiple organ failure in disseminated intravascular coagulation in spite of much activation of blood coagulation". Crit. Care Med. 29 (6): 1164–8. PMID 11395595.
- ↑ 3.0 3.1 3.2 Takahashi H, Tatewaki W, Wada K, Hanano M, Shibata A (February 1990). "Thrombin vs. plasmin generation in disseminated intravascular coagulation associated with various underlying disorders". Am. J. Hematol. 33 (2): 90–5. PMID 1689102.
- ↑ 4.0 4.1 4.2 Asakura H, Jokaji H, Saito M, Uotani C, Kumabashiri I, Morishita E, Yamazaki M, Aoshima K, Matsuda T (October 1994). "Study of the balance between coagulation and fibrinolysis in disseminated intravascular coagulation using molecular markers". Blood Coagul. Fibrinolysis. 5 (5): 829–32. PMID 7865691.
- ↑ 5.0 5.1 5.2 Asakura H, Jokaji H, Saito M, Uotani C, Kumabashiri I, Morishita E, Yamazaki M, Matsuda T (March 1991). "Changes in plasma levels of tissue-plasminogen activator/inhibitor complex and active plasminogen activator inhibitor in patients with disseminated intravascular coagulation". Am. J. Hematol. 36 (3): 176–83. PMID 1899963.