Pathophysiologic Features of Disseminated Intravascular Coagulation Characterized According to the Underlying Disorders

In order to characterize and compare the variable activation of blood coagulation and fibrinolysis in disseminated intravascular coagulation (DIC) associated with various underlying disorders, plasma levels of thrombin-antithrombin III complex (TAT), plasmin-α_2-plasmin inhibitor complex (PIC), fibrinogen degradation products (FgDP), fibrin degradation products (FbDP) and fibrinogenolysis plus fibrinolysis products (TDP) were measured together with standard hemostatic parameters in 80 patients with DIC at presentation. TAT, PIC, FbDP and FgDP were in general markedly elevated in these patients, demonstrating that excessive amounts of thrombin and plasmin are actually generated and not only fibrinolysis but also fibrinogenolysis are markedly accelerated in DIC. When analyzed according to the underlying disease categories, patients with acute promyelocytic leukemia (APL) had the highest PIC, PIC/TAT and FgDP/TDP ratios and remarkably decreased α_2-plasmin inhibitor and fibrinogen, indicating that the most excessive fibrinolysis can occur in APL. Similar profiles, although less marked, were observed in other leukemias and vascular diseases. Patients with sepsis had the lowest PIC, PIC/TAT and FgDP/TDP ratios, low antithrombin III and low protein C without a decrease in α_2-plasmin inhibitor, demonstrating a relatively impaired fibrinolysis. Patients with cancer had a relatively high TAT. These findings suggest that, although laboratory manifestations in DIC are extremely variable from patient to patient, underlying disorders are, at leaset in part, responsible for the observed variations. Recognition of these variable activation of coagulation and fibrinolysis would be helpful for the proper management of patients with DIC