Abstract
Disseminated intravascular coagulation (DIC) and associated multi-organ failure are
serious and often terminal events of a variety of non-septic conditions. For the most
part, these conditions are a result of tissue factor (thromboplastin) release from
damaged tissues creating situations that favor thrombin formation. Thrombin's role
in this process is critical and serves to induce the coagulopathy, as well as many
of the other aspects of inflammation that contribute to the associated morbidity and
mortality.
Clinical disorders giving rise to DIC fall into categories of trauma, obstetrical
complications, malignancies and a variety of inflammatory conditions. Diagnostic patterns
for these disorders are well established with an expected decrease in platelets and
fibrinogen, as well as antithrombin III, in addition to elevated levels of thrombin-antithrombin
III complex, prothrombin fragment 1 + 2, and D-dimer; all of which serve to identify
the hypercoagulable state.
Management of these coagulopathies requires attention to the bleeding diathesis and
the ongoing thrombotic complication. Supportive therapy usually is required to provide
hemostasis. However, control of the coagulopathy is of equal importance and requires
not only early intervention, but also administration of sufficient antithrombotic
agents to reduce thrombin's ability to consume coagulation factors, as well as to
stimulate inflammatory processes. Heparin has been employed effectively in many of
these situations, but suffers from its potential to induce hemorrhage. Antithrombin
III concentrate, however, is devoid of this risk and provides a unique alternative
that has had a limited, but effective record of benefits. Further proof of its efficacy
in multi-organ failure disorders is awaited.
Key words:
Disseminated intravascular coagulation (DIC) - trauma - antithrombin III concentrate
- multiple organ failure - acute respiratory distress syndrome - microvascular thrombosis
