Abstract Number: PB0799
Meeting: ISTH 2020 Congress
Background: The functional dynamics of coagulation and fibrinolysis in patients with disseminated intravascular coagulation (DIC) vary extensively owing to various underlying diseases and severities. Conventional measurements of coagulation and fibrinolysis such as TAT, PIC, AT, FDP may not always reflect the precise pathophysiologic condition of DIC.
Aims: We aimed to establish novel classification of DIC with simultaneous assessment of both comprehensive coagulation and fibrinolysis dynamics in patients with sepsis-associated DIC.
Methods: Plasma samples obtained from 57 patients at the time of initial diagnosis with sepsis-associated DIC from September 2016 to July 2019 were evaluated. Comprehensive coagulation and fibrinolysis dynamics were quantitatively evaluated by clot-fibrinolysis waveform analysis (CFWA) and thrombin/plasmin generation assay (T/P-GA) (Nogami.K;Br J Haematol. 2019, Matsumoto T; Thromb.Haemost.2013). The results were expressed as the ratios relative to normal plasma.
Results: CFWA results demonstrated that the maximum coagulation velocity (|min1|) ratio underwent a modest increase to 1.30 ± 0.67 but the maximum fibrinolytic velocity (|FL-min1|) ratio decreased to 0.61 ± 0.33. T/P-GA results showed that the peak thrombin (Th-Peak) ratio moderately decreased to 0.72 ± 0.27, whereas the peak plasmin (Plm-Peak) ratio substantially decreased to 0.46 ± 0.35. |min1| and Th-Peak ratio correlated with one another (R=0.47, P< 0.001 ). |FL-min1| and Plm-Peak ratio strongly correlated (R=0.72, P< 0.001) , suggesting that CFWA reflect thrombin plasmin generation. With |min1|) and |FL-min1| ratio DIC could be classified as follows: coagulation-predominant, coagulation/fibrinolysis-balanced, fibrinolysis-predominant, and consumption-impaired coagulation. Most patients (80.7%) in our cohort displayed coagulation-predominant disease.
Conclusions: A new classification of sepsis-associated DIC based on comprehensive assessment of coagulation and fibrinolysis dynamics would be greatly helpful for the diagnosis, hemostatic monitoring and decision of optimal treatment.
To cite this abstract in AMA style:Onishi T, Nogami K, Ishihara T, Inoue S, Kawaguchi M, Nishio K, Fukushima H, Kobayashi H, Amano I, Nishikubo T, Yamasaki M, Kasahara M, Shima M. A New Classification of Sepsis-Associated Disseminated Intravascular Coagulation (DIC) Based on Comprehensive Evaluation of Coagulation and Fibrinolysis [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/a-new-classification-of-sepsis-associated-disseminated-intravascular-coagulation-dic-based-on-comprehensive-evaluation-of-coagulation-and-fibrinolysis/. Accessed March 3, 2021.
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