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• Hypercoagulable (Stage I)
• Secondary fibrinolytic (Stage II)
• Hypocoagulable (Stage III)
In summary, the release of TF, together with FVIIa, initiates the extrinsic coagulation
cascade and, if it is not anticoagulated accordingly, with heparin low molecular weight
heparin (LMWH), or activated protein C (APC) can result in microthrombosis of the
capillaries of major organs, leading to Acute Respiratory Distress Syndrome (ARDS),
multiple organ failure (MOF), miscarriage, clotted graft, pulmonary embolism (PE), acute
myocardial infarct (AMI), stroke, and deep vein thrombosis (DVT). Fortunately, the high
concentration of thrombin activates the endothelium to release tissue plasminogen activator
(TPA), which activates plasminogen into plasmin -- the enzyme that breaks down the clot
before microthrombotic the capillaries of major organs. This process leads to stage II DIC,
secondary fibrinolysis.
Hypocoagulable phase (Stage III) The hypocoagulable phase leads to hemorrhage, but
can be treated by FFP, cryo, and platelets to stop the bleeding. Unfortunately, these
allogenic blood products, in addition to exposing the patient to donor blood products and the
risk of blood-borne diseases, also initiates strong inflammatory reactions and can reinstate
the prothrombotic state of DIC stage I in a much aggravated patient hemostasis state.
Another risk of DIC in secondary fibrinolysis is that a laboratory test panel will be run, and
tests will be normal for PT, PTT, fibrinogen level, platelets, but not for D-DIMER. The
common wisdom is to give Amicar or Aprotinin to normalize D-DIMER, but the doing that
blocks the pathway to breaking down the clot formation.
By identifying DIC in stage I with the Sonoclot Analyzer, then treating according to the
anticoagulation regimen for both enzymatic and platelet activations, and remedying the
source of TF release and balancing the patient's hemostasis, and can stop the initial DIC in
its earliest stage.