The Pathophysiology of Disseminated Intravascular Coagulation

Hugo ten Cate; Janneke J. Timmerman; Marcel Levi

doi:10.1055/s-0037-1615901

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 1999; 82(02): 713-717
DOI: 10.1055/s-0037-1615901

Research Article

Schattauer GmbH

The Pathophysiology of Disseminated Intravascular Coagulation

Authors

Hugo ten Cate

¹Department of Internal Medicine, Slotervaart Hospital, Laboratory for Experimental Internal Medicine, Center of Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Center, Amsterdam, THE NETHERLANDS
Janneke J. Timmerman

¹Department of Internal Medicine, Slotervaart Hospital, Laboratory for Experimental Internal Medicine, Center of Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Center, Amsterdam, THE NETHERLANDS
Marcel Levi

¹Department of Internal Medicine, Slotervaart Hospital, Laboratory for Experimental Internal Medicine, Center of Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Center, Amsterdam, THE NETHERLANDS

Abstract

Introduction

Disseminated intravascular coagulation (DIC) can be defined as “an acquired syndrome characterized by the activation of intravascular coagulation up to intravascular fibrin formation. The process may be accompanied by secondary fibrinolysis or inhibited fibrinolysis.”¹ Being an acquired disorder, DIC occurs in a wide range of underlying disease states, including sepsis (both by Gram positive and Gram negative bacteria), burns, preeclampsia, malignancy, and polytrauma.¹ In the majority of conditions, the pathogenesis of DIC remains only partly understood, an exception is Gram negative septicemia. In the following chapter, we will discuss the presumed mechanism by which DIC is elicited in different pathological states. The initiation of DIC follows the presentation of the glycoprotein tissue factor (TF) at a cellular surface, being either an intact or perturbed cell, or a cell membrane remnant.² The extracellular TF molecules may interact with circulating factor VIIa to form a catalytic complex. The complex binds the coagulation zymogen factors IX and X. This leads to proteolytic cleavage of these molecules, yielding enzymatically active factors IXa and Xa and promoting the activation of prothrombin to thrombin (Fig. 1).

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References
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