Microvascular coagulopathy and disseminated intravascular coagulation.
OBJECTIVE
To review the dual characteristics of disseminated intravascular coagulation (DIC), as both a contributor to multiple organ failure as well as a symptom of severe underlying disease associated with systemic vascular changes.


METHODS
Published literature data and unpublished results from the authors.


METHODS
Clinical and experimental studies strongly suggest that DIC contributes to multiple organ failure and death in patients with severe systemic disorders such as sepsis. DIC is evoked by systemic cytokine activity, and the inflammatory response aggravates vascular permeability, inflammation, and cell damage in tissues. In addition to intravascular fibrin formation, thrombin and fibrin generation in tissues is also an important aspect of DIC. An example of DIC at the organ level is adult respiratory distress syndrome, where fibrin in the lung is a characteristic feature. Intravascular fibrin formation and occlusion may elicit a hypoxic response with induction of hypoxia related transcription factors. The resulting ischemic preconditioning may offer protective effects to the involved organ(s).


CONCLUSIONS
Overall, the beneficial or harmful effects of activated coagulation and fibrin formation for organ pathology and recovery from DIC remain to be explored. This may be a critical element in the assessment of ischemia-reperfusion effects of specific anticoagulant therapy.
ten Cate
H
H
Academic Medical Center, and the Department of Internal Medicine, Slotervaat Hospital, Amsterdam, The Netherlands.
Schoenmakers
S H
SH
Franco
R
R
Timmerman
J J
JJ
Groot
A P
AP
Spek
C A
CA
Reitsma
P H
PH
D000925:Anticoagulants / Q000627:therapeutic use; D002199:Capillary Permeability / Q000502:physiology; D016207:Cytokines / Q000502:physiology; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology* / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000502:physiology*; D005337:Fibrin / Q000502:physiology; D006801:Humans; D007249:Inflammation; D008833:Microcirculation; D009102:Multiple Organ Failure / Q000097:blood / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology* / Q000503:physiopathology; D012128:Respiratory Distress Syndrome / Q000382:microbiology; D018805:Sepsis / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D013917:Thrombin / Q000502:physiology
D000925:Anticoagulants; D016207:Cytokines; D005337:Fibrin; D013917:Thrombin