PURPOSE: The aims of the present study were to confirm the consumption coagulopathy of disseminated intravascular coagulation (DIC) with the fibrinolytic phenotype at an early phase of trauma and to test the hypothesis that thrombin-activatable fibrinolysis inhibitor (TAFI), neutrophil elastase and plasmin contribute to the increased fibrinolysis of this type of DIC. Furthermore, we hypothesized that DIC at an early phase of trauma dependently continued to DIC with a thorombotic phenotype at from 3 to 5 days after the injury.
METHODS: Fifty-seven trauma patients: 30 with DIC; 27 without DIC were prospectively studied. Levels of TAFI, tissue-type plasminogen activator plasminogen activator inhibitor-1 complex (tPAIC), plasmin alpha2 plasmin inhibitor complex (PPIC), D-dimer, neutrophil elastase, and fibrin degradation product by neutrophil elastase (EXDP) were measured on days 1, 3, and 5 following trauma. The prothrombin time, fibrinogen, FDP, and antithrombin as well as lactate were also measured.
RESULTS: Independent of the lactate levels, DIC patients showed prolonged prothrombin time, lower fibrinogen and antithrombin levels and elevated levels of FDP on day 1. DIC diagnosed on day 1 continues to late-phase DIC on days 3 and 5 after trauma. Elevated levels of tPAIC, PPIC, D-dimer, neutrophil elastase, and EXDP but not TAFI were observed in DIC patients. No correlation was observed between PPIC and EXDP in DIC patients. Multiple regression analysis showed the DIC score and the tPAIC levels on day 1 to correlate with the total volume of transfused blood. Prognosis was deteriorated in accordance with DIC severity.
CONCLUSION: Independent of hypoperfusion, DIC at an early phase of trauma is associated with consumption coagulopathy and excessive fibrinolysis both by plasmin and neutrophil elastase, and continues to DIC at a late phase of trauma. Increased fibrinolysis requires more blood transfusions, contributing to a poor patient outcome.
CLINICAL IMPLICATIONS: This study provides fundamental basis for the treatment of bleeding at an early phase of trauma.
DISCLOSURE: Atsushi Sawamura, No Financial Disclosure Information; No Product/Research Disclosure Information