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Semin Thromb Hemost 2024; 50(04): 569-579
DOI: 10.1055/s-0043-1776878
Review Article

Disseminated Intravascular Coagulation in Anaphylaxis

Georg Gelbenegger
1   Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
,
Nina Buchtele
2   Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
,
Christian Schoergenhofer
1   Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
,
Jürgen Grafeneder
3   Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
,
Michael Schwameis
3   Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
,
Peter Schellongowski
2   Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
,
Wolfgang Denk
4   Austrian Society of Forensic Medicine, Vienna, Austria
,
Bernd Jilma
1   Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
› Author Affiliations Funding G.G. is supported by grant SFB54-P04 from the Austrian Science Funds.
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Abstract

Anaphylaxis is a life-threatening condition that involves severe cutaneous, respiratory, and cardiovascular symptoms. Disseminated intravascular coagulation (DIC) is an acquired, widespread activation of coagulation that can be caused by infectious conditions (e.g., sepsis) and noninfectious conditions. The onset of DIC following anaphylaxis is not commonly known, and information regarding the pathomechanism linking anaphylaxis to DIC is scarce. Further, demographic and clinical data in anaphylaxis-induced DIC are still missing to this day. Triggered by a case of anaphylaxis-induced DIC that seamlessly transitioned to lethal sepsis-induced DIC, we aimed to characterize the patient population affected by anaphylaxis-induced DIC by performing a review of existing literature and expand the discussion to underlying mechanisms. The overall mortality of the patient cohort (n = 30) identified by the literature review was 50%. All patients that died either suffered a bleeding event or a thrombotic event. The majority of patients (n = 25/30; 83%) had bleeding events; thrombotic events were only reported in nonsurvivors (n = 9/15 or 60% of nonsurvivors; vs. n = 0/15 in survivors; p < 0.001). Nonsurvivors of anaphylaxis-induced DIC were on average 25 years older than survivors (p = 0.068). In conclusion, DIC can complicate anaphylaxis and is expected to contribute to poor microvascular perfusion after anaphylaxis. Particularly, elderly patients with known cardiovascular disease and patients who develop thrombotic events are susceptible to lethal outcomes. As a rare and largely uncharacterized disease entity, further research is needed to investigate the link between DIC and anaphylaxis and to potentially identify better treatment strategies.

Keywords

disseminated intravascular coagulation - anaphylaxis - cardiac arrest - coagulation - fibrinolysis - platelet - thrombosis - bleeding

Supplementary Material



Publication History

Article published online:
29 November 2023

© 2023. Thieme. All rights reserved.

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