Rytis Trojanas1
1Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Abstract
Background. Disseminated intravascular coagulation is a condition in which systemic coagulation is activated, resulting in large amounts of fibrin in the lumen of small and midsize blood vessels. Thrombi made out of fibrin can disrupt blood flow to internal organs, causing multiple organ dysfunction syndrome. Gradual depletion of platelets and coagulation factors can result in bleeding and hemorrhagic necrosis, which can become the predominant sign of the disseminated intravascular coagulation.
Aim: to review the newest literature and articles about disseminated intravascular coagulation, its pathophysiology, diagnostics and treatment options.
Methods. The research of literature was conducted using PubMed, Wiley Online Library, Elsevier international databases. Keywords and their combinations were used during research: disseminated intravascular coagulation, coagulopathy, fibrinolysis, platelets, thrombocytopenia. 30 publications were analyzed and included.
Conclusions. Disseminated intravascular coagulation is not a disease in itself, rather it occurs as a complication of systemic inflammation in sepsis, major trauma, malignant tumors or obstetric calamities. During systemic inflammation, large amount of tissue factor is exposed, consequently coagulation system is activated. Due to prolonged activation of coagulation, physiological anticoagulation and endogenous fibrinolysis are disturbed, also the activation of platelets is triggered. These processes result in generation of huge amounts of thrombin and fibrin. At the same time the risk of bleeding increase because of usage of platelets and coagulation factors. Disseminated intravascular coagulation diagnosis is based on international diagnostic criteria, which include platelet count, prothrombin time or international normalization ratio and the concentration of fibrin degradation products, like D-dimers. The keystone of treatment in disseminated intravascular coagulation is to treat the disease, which caused the syndrome at the first place.
Keywords: disseminated intravascular coagulation, coagulopathy, fibrinolysis, platelets, thrombocytopenia.