Coagulación intravascular diseminada: Una revisión de tema

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Abstract

Resumen Introducción: La Coagulación Intravascular Diseminada, es un síndrome secundario a patologías subyacentes, donde la activación localizada de la coagulación y la respuesta inflamatoria generalizada, pueden llevar a daños tisulares y microvasculares. Se ha reportado una prevalencia del 10,8% en varias unidades de cuidados intensivos de Colombia; su presentación en el contexto de sepsis es diferente según el tipo de infección. Objetivo: Realizar una revisión de la literatura de los conceptos más destacados de la Coagulación Intravascular Diseminada. Materiales y métodos: Se realizó una revisión por medio de la búsqueda de artículos originales, revisiones sistemáticas y narrativas, en las bases de datos PubMed y ScienceDirect y en el buscador Google Académico; se seleccionaron 80 artículos, de los cuales se incluyeron 51. Se tuvo en cuenta publicaciones en español, inglés y francés, con fecha de publicación menor o igual a 5 años. Resultados: Se realizó la descripción sobre tratamiento, etiología, presentación clínica y diagnóstico de la Coagulación Intravascular Diseminada, haciendo especial énfasis en los estudios sobre marcadores moleculares y nuevas alternativas terapéuticas. Conclusión: La Coagulación Intravascular Diseminada es una complicación que contribuye a aumentar la morbilidad y la mortalidad, cuyo pronto diagnóstico y tratamiento aportan significativamente a una mejor evolución clínica.

Translated abstract

Abstract Introduction: Disseminated intravascular coagulation is a secondary syndrome to underlying pathologies, where localized coagulation activation and generalized inflammatory response can lead to tissue and microvascular damage. A prevalence of 10.8% has been reported in several intensive care units in Colombia. Its presentation in the context of sepsis is different depending on the type of infection. Objective: To conduct a review of literature of the most outstanding concepts of disseminated intravascular coagulation. Materials and methods: A review was made by means of the search of original articles, systematic and narrative reviews, in the PubMed and ScienceDirect databases and in the Google Scholar search engine; 80 articles were selected, of which 51 were included. Publications were taken into account in Spanish, English and French, with a publication date of less than or equal to 5 years. Results: The description of treatment, etiology, clinical presentation and diagnosis of Disseminated Intravascular Coagulation was made, with special emphasis on the studies on molecular markers and new therapeutic alternatives. Conclusion: Disseminated intravascular coagulation is a complication which contributes to increase morbidity and mortality, whose early diagnosis and treatment contribute significantly to better clinical evolution.

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Most cited references 47

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Andreea A. Creanga, Cynthia Berg, Carla Syverson … (2015)

To update national population-level pregnancy-related mortality estimates and examine characteristics and causes of pregnancy-related deaths in the United States during 2006-2010.

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A randomized, double-blind, placebo-controlled, Phase 2b study to evaluate the safety and efficacy of recombinant human soluble thrombomodulin, ART-123, in patients with sepsis and suspected disseminated intravascular coagulation.

James K. Tsuruta, Mark Crowther, Howard Levy … (2013)

To determine the safety and efficacy of recombinant thrombomodulin (ART-123) in patients with suspected sepsis-associated disseminated intravascular coagulation. Phase 2b, international, multicenter, double-blind, randomized, placebo-controlled, parallel group, screening trial. Two hundred and thirty-three ICUs in 17 countries. All adult patients admitted with sepsis and suspected disseminated intravascular coagulation as assessed using a modified International Society on Thrombosis and Hemostasis score. Patients were randomized to receive IV ART-123 (0.06 mg/kg/d) for 6 days or placebo, in addition to standard of care. The primary endpoint was reduction in mortality. Secondary endpoints included reversal of overt disseminated intravascular coagulation and reduction in disease severity. A total of 750 patients were randomized, nine of whom did not receive the allocated treatment so that 371 patients received ART-123 and 370 received placebo. There were no meaningful differences between the two groups in any of the baseline variables. Twenty-eight-day mortality was 17.8% in the ART-123 group and 21.6% in the placebo group (Cochran-Mantel-Haenszel two-sided p value of 0.273 in favor of ART-123, which met the predefined statistical test for evidence suggestive of efficacy). There were no statistically significant differences in event-free and alive days between the two groups. d-dimer, prothrombin fragment F1.2 and TATc concentrations were lower in the ART-123 group than in the placebo group. There were no differences between the two groups in organ function, inflammatory markers, bleeding or thrombotic events or in the development of new infections. In post hoc analyses, greatest benefit from ART-123 was seen in patients with at least one organ system dysfunction and an international normalized ratio greater than 1.4 at baseline. ART-123 is a safe intervention in critically ill patients with sepsis and suspected disseminated intravascular coagulation. The study provided evidence suggestive of efficacy supporting further development of this drug in sepsis-associated coagulopathy including disseminated intravascular coagulation. Future study should focus on using ART-123 in the subgroup of patients most likely to respond to this agent.

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Low-dose heparin as treatment for early disseminated intravascular coagulation during sepsis: A prospective clinical study

Xiao-Li Liu, Xiao-Zhi Wang, XIU-XIANG LIU … (2013)

The present study aimed to investigate whether low-dose heparin improves the condition of patients suffering from early disseminated intravascular coagulation (pre-DIC) during sepsis. In total, 37 patients were randomly divided into low-dose heparin intervention and control groups. The heparin group received a low-dose of heparin for 5–7 days, while the other group received only saline. The two groups were treated for sepsis. Blood samples were collected at various times and acute physiology and chronic health evaluation (APACHE)-II scores were recorded at day 1 and 7. In addition, the number of days applying mechanical ventilation and in the intensive care unit (ICU) were recorded, as well as the 28-day mortality rate. APACHE-II scores in the two groups decreased following treatment, however, scores in the heparin group decreased more significantly. Prothrombin fragment and thrombin-antithrombin complex levels in the heparin group were significantly decreased. In addition, the number of days applying a ventilator was fewer and the total stay in ICU was significantly shorter compared with the control group. Significantly fewer complications were observed in the heparin group, however, there was no significant difference in the 28-day mortality rate. In conclusion, low-dose heparin improves the hypercoagulable state of sepsis, which subsequently reduces the incidence of DIC or multiple organ dysfunction syndrome, decreasing the number of days of mechanical ventilation and hospitalization.

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Author and article information

Contributors

Alejandro Hernández-Martínez: Role: ND

Lina María Martínez-Sánchez: Role: ND

Journal

Journal ID (publisher-id): reus

Title: Universidad y Salud

Abbreviated Title: Univ. Salud

Publisher: Universidad de Nariño (Pasto, Nariño, Colombia )

ISSN (Print): 0124-7107

ISSN (Electronic): 2389-7066

Publication date (Print and electronic): December 2018

Volume: 20

Issue: 3

Pages: 283-291

Affiliations

[1] Medellín orgnameUniversidad Pontificia Bolivariana orgdiv1Facultad de Medicina orgdiv2Grupo de Investigación Medicina Interna Colombia

Article

Publisher ID: S0124-71072018000300283

DOI: 10.22267/rus.182003.132

SO-VID: bf1d0fb5-850d-4732-a9d3-ef1385e80625

License:

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

History

Date accepted : 14 August 2018

Date received : 25 September 2017

Page count

Figures: 0, Tables: 0, Equations: 0, References: 51, Pages: 9

Product

SciELO Colombia

Keywords: Coagulación intravascular diseminada,Disseminated intravascular coagulation,anticoagulantes,anticoagulants,sepsis

Data availability:

Keywords: Coagulación intravascular diseminada, Disseminated intravascular coagulation, anticoagulantes, anticoagulants, sepsis

Coagulación intravascular diseminada: Una revisión de tema Translated title: Disseminated intravascular coagulation: A review of the topic

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