Download PDF
Semin Thromb Hemost 2001; 27(6): 585-592
DOI: 10.1055/s-2001-18864
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Disseminated Intravascular Coagulation in Trauma Patients

Satoshi Gando
  • Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Further Information

Publication History

Publication Date:
06 December 2001 (online)

    Permissions and Reprints

ABSTRACT

Disseminated intravascular coagulation (DIC) is characterized by the in vivo activation of the coagulation system, which results in the intravascular deposition of fibrin and consumption bleeding. DIC is a serious hemostatic complication of trauma. It can be clearly distinguished from physiological hemostatic response to trauma by using sensitive coagulofibrinolytic molecular markers. Physiological hemostasis to injuries is similar in all kinds of trauma without exception. There is an increase in circulating proinflammatory cytokines in DIC patients after trauma. Elevated cytokines induce tissue factor-mediated activation of coagulation, suppression of the anticoagulant pathway, and plasminogen activator inhibitor-1 (PAI-1)-mediated inhibition of fibrinolysis followed by disseminated fibrin deposition in the microvasculature. In addition to the occlusive microvascular thrombosis and hypoxia, sustained systemic inflammatory response characterized by neutrophil activation and endothelial damage plays a pivotal role in the development of multiple organ dysfunction syndrome (MODS) in posttrauma DIC patients. DIC associated with sustained systemic inflammatory response syndrome (SIRS) after trauma leads to the development of MODS, which is the main determinant of patients' outcome after trauma.

KEYWORD

Disseminated intravascular coagulation (DIC) - trauma - multiple organ dysfunction syndrome (MODS) - systemic inflammatory response syndrome (SIRS) - inflammation

REFERENCES

  • 1 Levi M, de Jonge E, van der Poll T, ten Cate H. Disseminated intravascular coagulation.  Thromb Haemost . 1999;  82 695-705
    PubMedGoogle Scholar
  • 2 Cicala C, Cirino G. Linkage between inflammation and coagulation: An update on the molecular basis of the crosstalk.  Life Sci . 1998;  62 1817-1824
    CrossrefPubMedGoogle Scholar
  • 3 Members of American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis.  Crit Care Med . 1992;  20 864-874
    CrossrefPubMedGoogle Scholar
  • 4 Gando S, Tedo I, Kubota M. Posttrauma coagulation and fibrinolysis.  Crit Care Med . 1992;  20 594-600
    CrossrefPubMedGoogle Scholar
  • 5 Gando S, Nakanishi Y, Tedo I. Cytokines and plasminogen activator inhibitor-1 in posttrauma disseminated intravascular coagulation: Relationship to multiple organ dysfunction syndrome.  Crit Care Med . 1995;  23 1835-1842
    CrossrefPubMedGoogle Scholar
  • 6 Seyfer A E, Seaber A V, Dombrose F A, Urbaniak J R. Coagulation changes in elective surgery and trauma.  Ann Surg . 1981;  193 210-213
    PubMedGoogle Scholar
  • 7 Kluft C, Verheijen J H, Jie A FH. The postoperative fibrinolytic shutdown: A rapidly reverting acute phase pattern for the fast-acting inhibitor of tissue-type plasminogen activator after trauma.  Scand J Clin Lab Invest . 1985;  45 605-610
    CrossrefPubMedGoogle Scholar
  • 8 Kapsch D N, Metzler M, Harrington M. Fibrinolytic response to trauma.  Surgery . 1984;  95 473-478
    PubMedGoogle Scholar
  • 9 Risberg B, Medegård A, Heideman M. Early activation of humoral proteolytic systems in patients with multiple trauma.  Crit Care Med . 1986;  14 917-925
    PubMedGoogle Scholar
  • 10 Goodnight S H, Kenoyer G, Rapaport S I. Defibrination after brain-tissue destruction. A serious complication of head injury.  N Engl J Med . 1974;  290 1043-1047
    CrossrefPubMedGoogle Scholar
  • 11 Disseminated intravascular coagulation and head injury.  Lancet (Editorial) . 1982;  2 531
    PubMedGoogle Scholar
  • 12 >Abnormal blood clotting after head injury.  Lancet (Review) . 1989;  2 957-958
    PubMedGoogle Scholar
  • 13 Gando S, Nanzaki S, Kemmotsu O. Coagulofibrinolytic changes after isolated head injury are not different from those in trauma patients without head injury.  J Trauma . 1999;  46 1070-1077
    CrossrefPubMedGoogle Scholar
  • 14 Levi M, ten Cate H, van der Poll T, van Deventer J H S. Pathogenesis of disseminated intravascular coagulation in sepsis.  JAMA . 1993;  270 975-979
    CrossrefPubMedGoogle Scholar
  • 15 Gando S, Nanzaki S, Morimoto Y. Tissue factor pathway inhibitor response does not correlate with tissue-factor induced DIC and MODS in trauma patients.  Crit Care Med . 2001;  24 262-266
    PubMedGoogle Scholar
  • 16 Gando S. Serial studies of protein C in trauma patients.  Jpn J Thromb Hemost [in Japanese] . 1996;  7 312-318
    PubMedGoogle Scholar
  • 17 Owings J T, Gosselin R. Acquired antithrombin deficiency following severe traumatic injury: Rationale for study of antithrombin supplementation.  Semin Thromb Hemost . 1997;  23(Suppl 1) 17-24
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Gando S, Nakanishi Y, Kameue T, Nanzaki S. Soluble thrombomodulin increases in patients with disseminated intravascular coagulation and in those with multiple organ dysfunction syndrome after trauma: Role of neutrophil elastase.  J Trauma . 1995;  39 660-664
    CrossrefPubMedGoogle Scholar
  • 19 Donnelly S C, Robertson C R. Mediators, mechanisms and mortality in major trauma.  Resuscitation . 1994;  28 87-92
    CrossrefPubMedGoogle Scholar
  • 20 Moor F A, Sauaia A, Moor E E. Postinjury multiple organ failure: A bimodal phenomenon.  J Trauma . 1996;  40 501-512
    PubMedGoogle Scholar
  • 21 Yao Y M, Redl H, Bahrami S, Schlag G. The inflammatory basis of trauma/shock-associated multiple organ failure.  Inflamm Res . 1998;  47 201-210
    CrossrefPubMedGoogle Scholar
  • 22 Penner J A. Disseminated intravascular coagulation in patients with multiple organ failure of non-septic origin.  Semin Thromb Hemost . 1998;  24 45-52
    PubMedGoogle Scholar
  • 23 Gando S, Kameue T, Nanzaki S. Increased neutrophil elastase, persistent intravascular coagulation, and decreased fibrinolytic activity in patients with posttraumatic acute respiratory distress syndrome.  J Trauma . 1997;  42 1068-1072
    PubMedGoogle Scholar
  • 24 Gando S, Nanzaki S, Morimoto Y. Systemic activation of tissue-factor dependent coagulation pathway in evolving acute respiratory distress syndrome in patients with trauma and sepsis.  J Trauma . 1999;  47 719-723
    PubMedGoogle Scholar
  • 25 Taylor F B, Chang A CK, Peer G T. DEGR-Factor Xa blocks disseminated intravascular coagulation initiated by Escherichia coli without preventing shock or organ damage.  Blood . 1991;  78 364-368
    PubMedGoogle Scholar
  • 26 Taylor F B, Stearns-Kurosawa J, Ferrell G. The endothelial cell protein C receptor aids in host defense against Echerichia coli sepsis.  Blood . 2000;  95 1680-1686
    PubMedGoogle Scholar
  • 27 Cirino G, Cicala C, Bucci M. Factor Xa as an interface between coagulation and inflammation.  J Clin Invest . 1997;  99 2446-2451
    PubMedGoogle Scholar
  • 28 Nast-Kolb D, Waydhas C, Gippner-Steppert C. Indicator of the posttraumatic inflammatory response correlate with organ failure in patients with multiple injuries.  J Trauma . 1997;  42 446-455
    PubMedGoogle Scholar
  • 29 Gando S, Kameue T, Nanzaki S. Participation of tissue factor and thrombin in posttraumatic systemic inflammatory syndrome.  Crit Care Med . 1997;  25 1820-1826
    CrossrefPubMedGoogle Scholar
  • 30 Gando S, Nanzaki S, Kemmotsu O. Disseminated intravascular coagulation and sustained systemic inflammatory response syndrome predict organ dysfunctions after trauma. Application of clinical decision analysis.  Ann Surg . 1999;  229 121-127
    CrossrefPubMedGoogle Scholar