Chapter category: Coagulation
DIC at the Intersection of the Thrombotic, Fibrinolytic and Inflammatory Axes
Molecular Mechanisms of Disseminated Intravascular Coagulation
Edited by: Hugo ten CateISBN: 1-58706-058-2
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Chapter authors:
Sean P. Mazer, David J. Pinsky
Disseminated intravascular coagulation (DIC) is a common clinical syndrome with dichotomous presentations of hemorrhage and thrombosis with a common underlying pathophysiology. As a syndrome, DIC presents a spectrum of severity ranging from a chronic disorder with minimal hemolysis and coagulation to a fulminant disorder with uncontrollable hemorrhage and major organ failure from small vessel thrombosis. DIC occurs in many different diseases (Table 1). In its severest form it is one of the final steps leading to multi-system failure. In each case derangement of the normally dynamic complex balance between thrombosis and fibrinolysis results in either a dominant phenotype of microvascular clotting or hemorrhage. In the thrombotic phenotype, unregulated fibrin generation results in widespread coagulation, while in the hemorrhagic phenotype, unregulated plasmin generation results in fibrinolysis and proteolysis of all soluble clotting factors. Paradoxically, the hemorrhage associated with DIC is clinically more obvious, but the microvascular clotting is far more lethal. Several recent discoveries about prognosis and therapy in patients with DIC emphasize the fundamental importance of the microvascular clotting over that of hemorrhage. In DIC the diversity of causes makes a unifying description of its pathophysiology difficult. However, focussing on several of the more important cell types and enzymes clarifies how a group of diverse diseases causes this syndrome.
Additional chapters from this book:
Lessons from Venous Thrombosis and Disseminated Intravascular Coagulation: A Synthesis of Pathophysiological Mechanisms of Prothrombotic States
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Disseminated intravascular coagulation (DIC) is defined as an acquired syndrome characterized by widespread activation of coagulation leading to intravascular formation of fibrin and thromboti...
Blood Borne Tissue Factor (Including Microparticles)
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Minor amounts of biologically active tissue factor (TF) are always constitutively present in circulating blood of healthy individuals. In various diseases, including those underlying the in...
Endothelial Cell Perturbation and Disseminated Intravascular Coagulation
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Disseminated intravascular coagulation (DIC) is a life threatening condition that occurs due to a severe imbalance of the coagulation system. DIC is characterized by the combined occurrence of...
Regulation of Coagulation and Inflammation by the Thrombomodulin/Protein C System in Sepsis
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Thrombomodulin (TM) plays a role in regulation of the coagulation system not only by decreasing the procoagulant activities of thrombin, but by activation of protein C (PC) to form activated protein C...
DIC at the Intersection of the Thrombotic, Fibrinolytic and Inflammatory Axes
Sean P. Mazer, David J. Pinsky
Disseminated intravascular coagulation (DIC) is a common clinical syndrome with dichotomous presentations of hemorrhage and thrombosis with a common underlying pathophysiology. As a syndrome, DIC pres...
Cytokines as Regulators of Coagulation
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Contributions of the Plasma Kallikrein/Kinin System to Disseminated Intravascular Coagulation
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Disseminated intravascular coagulation (DIC) is a clinicopathologic state that arises from an imbalance between the degree of thrombin and plasmin formation. Most cases of DIC arise from tissue injury...
The Pleiotropic Effects of Tissue Factor
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Regulation of Tissue Factor Expression
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The cellular initiation of the coagulation protease cascade by tissue factor (TF) is the central pathway that initiates disseminated intravascular coagulation and contributes to lethality associated w...
