Coagulation and fibrinolysis balance in disseminated intravascular coagulation

Background Sepsis is a common underlying disease associated with disseminated intravascular coagulation (DIC). We have recently determined hemostatic pathological states at diagnosis through simultaneous assessment of coagulation and fibrinolysis potentials in sepsis‐associated DIC using clot‐fibrinolysis waveform analysis. Here we aimed to investigate hemostatic pathological states, focusing on the balance between coagulation and fibrinolysis dynamics during the clinical course in pediatric sepsis‐associated DIC. Methods Coagulation and fibrinolysis potential functions in three pediatric patients with sepsis‐associated DIC during their clinical course were quantified using clot‐fibrinolysis waveform analysis. A maximum coagulation velocity (|min1|) and maximum fibrinolysis velocity (|FL‐min1|) was calculated as a ratio relative to normal plasma. Results In case 1, coagulation‐enhanced and fibrinolysis‐depressed state (|min1|‐ratio 2.22 and |FL‐min1|‐ratio 0.42) was observed on day 1. This discrepancy significantly reduced after anticoagulant therapy and plasma exchange on day 2. A well‐balanced hemostatic state (0.70 and 0.62, respectively) was restored on day 7. In case 2, fibrinolysis‐impaired state (|min1|‐ratio 1.09 and |FL‐min1|‐ratio 0.21) was seen on day 1. The |min1| ratio was slightly prolonged and the |FL‐min1| ratio was severely decreased. Both were restored on day 7 and returned to normal levels on day 12. In case 3, twofold coagulation‐ and fibrinolysis‐enhanced states (|min1|‐ratio 1.99 and |FL‐min1|‐ratio 1.11) were seen on day 1. However, both potentials rapidly decreased on day 2 (0.49 and 0.0, respectively). She died on day 5. Conclusions The hemostatic pathological states in sepsis‐associated DIC depend on disease progression. Comprehensive assessment of coagulation‐fibrinolysis potentials over time may therefore be helpful in considering optimal treatment plans for sepsis‐associated DIC.