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
