Thrombohemorrhagic disorders

Severe illness such as Gram-negative sepsis, obstetric pathology, trauma, (intra)vascular disorders, or malignancy may lead to DIC ( t.eD.CMe...eLa.l 1993). DIC is a pathological condition in which large amounts of thrombin are generated due to activation of the coagulation system. This may lead to generalized thrombosis and multiple organ failure. In addition life-threatening hemorrhage may occur due to consumption of coagulation factors and activation of the fibrinolytic system ( T§ble 2).

Given the current spectrum of very sensitive assays for hemostatic activation (e.g. thrombin-antithrombin complexes, D-dimer, prothrombin fragment 1+2), it is likely that these assays will give abnormal results when used in a critical care patient.

For this reason we recommend the initial use of several conventional tests to diagnose DIC (in the absence of a gold-standard test) ( Ta.ble.2). Specific additional tests may be useful to support the suspicion and confirm the diagnosis, but should not be used as a single test until major clinical trials have established the relationship between a given level of an activation marker and clinical outcome. In the future, measurement of activation markers may provide a tool for determining the efficacy of anticoagulant therapy.

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