What tests should be performed?

Routine tests are performed, such as prothrombin time and activated partial thromboplastin time; they are prolonged due to consumption of clotting factors.

Levels of fibrinogen and Factors II, V, VII and X can be determined to demonstrate consumption coagulopathy; the levels of these factors are reduced in DIC.

The consumption of platelets during the pathophysiological process is also reflected by the platelet count.

Fibrin-related markers (soluble fibrin complexes (SFC), fibrin monomers (FM), fibrin and fibrinogen degradation products (FDP) and D-dimers) have long been used in the diagnosis and monitoring of DIC. Their levels are usually elevated.

The value of fibrin monomers (FM) as a prognostic marker in DIC has been apparent since the 1990s. A high FM level during the week after the patient’s admission into the intensive care unit is associated with higher mortality.
In the following decade, the FM level was confirmed to be a better marker of mortality risk than the D-dimer level.

More recently, in 2011, the value of combined FM and D-dimer measurement was demonstrated. The former is an indicator of fibrin formation, while the latter is an indicator of fibrinolysis, and a correlation has been shown between the ratio of D-dimer formation to FM formation and patient prognosis. In other words, the higher the rate of fibrinolysis relative to fibrin formation, the lower the thrombotic risk, so the risk of multiple organ failure is reduced. The combination of these two markers could be useful for assessing the survival prognosis of patients with DIC.


Literature:

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  • Levi M, Meijers JC. Blood Reviews 2011; 25: 33-37
  • Bredbacka S, Blomback M, Wiman B. Am J Hematol 1994; 46: 289-94
  • Taylor FB, Toh CH, Hoots WK, Wada H, Levi M. Thromb Haemost 2001; 86: 1327-30
  • Dempfle CE, Wurst M, Smolinski M, Lorenz S, Osika A, Olenik D, Fiedler F, Borggrefe M. Thromb Haemost 2004; 91: 812-8
  • Gris JC, Faillie JL, Cochery-Nouvellon E, Lissalde-Lavigne G, Lefrant JY. J Thromb Haemost 2011; 9: 1252-5

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