PURPOSE: Little is known about the clinical features of advanced gastric cancer (AGC) combined with disseminated intravascular coagulation (DIC). The main objective of this study was to determine the clinical outcome of patients with AGC complicated by DIC. MATERIALS AND METHODS: We conducted a retrospective review of 68 AGC patients diagnosed with DIC at four tertiary medical centers between January 1995 and June 2010. RESULTS: Sixty eight patients were included. The median age was 55 years (range, 25 to 78 years). Nineteen patients received chemotherapy, whereas 49 patients received only best supportive care (BSC). The median overall survival (OS) of the 68 patients was 16 days (95% confidence interval [CI], 11 to 21 days). Significantly prolonged OS was observed in the chemotherapy group, with a median survival of 61 days compared to 9 days in the BSC group (p<0.001, log-rank test). Age and previous chemotherapy were another significant factors that were associated with OS in univariate analysis. In multivariate analysis, age (> or =65 vs. <65; hazard ratio [HR], 0.38; 95% CI, 0.18 to 0.78; p<0.001), chemotherapy (BSC vs. chemotherapy; HR 0.31; 95% CI, 0.15 to 0.63; p<0.001), and previous chemotherapy (yes or no; HR, 0.49; 95% CI, 0.25 to 0.98; p<0.045) were consistently independent prognostic factors that impacted OS. CONCLUSION: Our study showed that patients with AGC complicated by DIC had very poor OS, and suggested that chemotherapy might improve OS of these patients.
Dacarbazine ; Disseminated Intravascular Coagulation* ; Drug Therapy* ; Humans ; Multivariate Analysis ; Retrospective Studies ; Stomach Neoplasms*

Gastric cancer patients with acute disseminated intravascular coagulation experiences a rare but severe complication resulting in a dismal prognosis. We report a case of advanced gastric cancer complicated with disseminated intravascular coagulation with intractable tumor bleeding which was successfully treated with chemotherapy consisting of 5-fluorouracil and oxaliplatin. The patient was a 63-year-old man who complained of abdominal pain, melena, and dyspnea on 24 November 2010. We diagnosed stage IV gastric cancer complicated by disseminated intravascular coagulation. Gastric tumor bleeding was not controlled after procedures were repeated three times using gastrofiberscopy. With the patient's consent, we selected the 5-fluorouracil and oxaliplatin combination chemotherapy for treatment. After one cycle of 5-fluorouracil and oxaliplatin therapy, symptoms of bleeding improved and the disseminated intravascular coagulation process was successfully controlled. The primary tumor and multiple metastatic bone lesions were remarkably shrunken and metabolically remitted after eight cycles of chemotherapy. In spite of progression, systemic chemotherapy is effective in disease control; further, the patient gained the longest survival time among cases of gastric cancer with disseminated intravascular coagulation.
Abdominal Pain ; Disseminated Intravascular Coagulation ; Drug Therapy, Combination ; Dyspnea ; Fluorouracil ; Hemorrhage ; Humans ; Melena ; Organoplatinum Compounds ; Prognosis ; Stomach Neoplasms

Anticoagulants ; therapeutic use ; Disseminated Intravascular Coagulation ; drug therapy ; etiology ; Heparin ; therapeutic use ; Humans ; Leukemia, Promyelocytic, Acute ; complications

Hemophagocytic lymphohistiocytosis (HLH) is a lifethreatening disorder due to hyperinflammation resulting in infiltration of different organs with extensive hemophagocytosis. Severe coagulopathy was one of the main reasons for death in HLH. Over secretion of plasminogen activator by activated macrophages leads to hyperfibrinolysis. We reported a 36-year-old woman who was diagnosed as HLH probably secondary to lymphoma. Massive bleeding from gut and retroperitoneal area were not able to be controlled by conventional hemostatic treatments. This patient received one dose recombinant activated factor VII (rFVIIa) 3.6 mg (70 μg/kg). Hemostatic effect was achieved in 0.5 hour and lasted 24 hours. Prothrombin time (PT) and activated partial thromboplastin time (APTT) were quickly corrected to normal ranges. Fibrinogen level elevated from 0.5 g/L before using rFVIIa to 1.8 g/L 20 hours after. Although dexamethasone and etopside were administrated to treat HLH, this patient died from septic shock after persistent neutropenia. This suggests that rFVIIa may be effective in the management of intractable hemorrhage in patients with HLH.
Adult ; Disseminated Intravascular Coagulation ; complications ; Factor VIIa ; therapeutic use ; Female ; Humans ; Lymphohistiocytosis, Hemophagocytic ; drug therapy ; Recombinant Proteins ; therapeutic use

The Sepsis Coagulopathy Asahi Recombinant LE Thrombomodulin (SCARLET) trial has many defects, and thus cannot be the terminator of recombinant thrombomodulin (rTM). On the contrary, it provides sufficient evidence for further research. Based on analysis focusing on the failure of SCARLET and several previous anticoagulant studies, it is most important for new studies to grasp the following two points: (1) The enrolled cases should have sufficient disease severity and a clear standard for disseminated intravascular coagulation; (2) Heparin should not be used in combination with the investigated drugs. Multiple post-hoc analyses show that no combination of heparin will not increase the risk of thromboembolism. In fact, the combination of heparin can mask the true efficacy of the investigated drug. Due to the complexity of sepsis treatment and the limitations of clinical studies, the results of all treatment studies should be repeatedly verified, rather than be determined at one stroke. Some research conclusions contrary to disease physiology, pharmacology and clinical practice may be deceptive, and should be cautious rather than be simply accepted. On the other hand, the dissenting voices in the "consensus" scene are often well discussed by the authors and should be highly valued.
Humans ; Anticoagulants/therapeutic use* ; Thrombomodulin/therapeutic use* ; Blood Coagulation Disorders ; Disseminated Intravascular Coagulation/drug therapy* ; Sepsis/drug therapy* ; Heparin/therapeutic use* ; Recombinant Proteins

PURPOSE: Few reports have been made on the therapeutic effects as well as pathological features of an antithrombin preparation in patients diagnosed with septic disseminated intravascular coagulation (DIC) by the diagnostic criteria for acute DIC. MATERIALS AND METHODS: A total of 88 sepsis patients who had received inpatient hospital care during the period from January 2000 through December 2008 were divided into two groups, an antithrombin group and a non-antithrombin group, to study the outcomes. Furthermore, the relationship between sepsis-related factors and DIC in 44 patients was studied. RESULTS: The antithrombin group contained 34 patients, and the non-antithrombin group contained 54 patients. The outcomes were significantly better in the antithrombin group. The levels of protein C were low in DIC patients. CONCLUSION: Our results suggest that early administration of antithrombin might improve outcomes of septic DIC patients in the diagnostic criteria for Japanese Association for Acute Medicine acute DIC.
Aged ; Disseminated Intravascular Coagulation/complications/diagnosis/*drug therapy ; Female ; Fibrinolytic Agents/*therapeutic use ; Humans ; Male ; Middle Aged ; Sepsis/complications/diagnosis/*drug therapy ; Time Factors ; Treatment Outcome

Acute disseminated intravascular coagulation (DIC) associated with gastric cancer is not common and has short survival of 1 to 3 weeks. Systemic chemotherapy in spite of hematologic unstability for gastric cancer may prolong survival time. A 47-year-old woman who complained of dyspnea, vaginal bleeding and easy bruisibility was diagnosed to stage IV gastric cancer with acute disseminated intravascular coagulation based on the laboratory data. She also had multiple bone metastases and bone marrow involvement. This is the first case treated with combination chemotherapy of irinotecan and cisplatin for advanced gastric cancer complicated by disseminated intravascular coagulation at the time of diagnosis. With systemic chemotherapy, some of the bleeding symptoms and the DIC process improved, even not completely recovered. However the patient died of disease progression and survival time was 12 weeks.
Bone Marrow ; Cisplatin* ; Dacarbazine ; Diagnosis ; Disease Progression ; Disseminated Intravascular Coagulation* ; Drug Therapy ; Drug Therapy, Combination* ; Dyspnea ; Female ; Hemorrhage ; Humans ; Middle Aged ; Neoplasm Metastasis ; Stomach Neoplasms* ; Uterine Hemorrhage

In recent years, the incidence of imported cases infested with Plasmodium falciparum has been increasing in Korea due to marked increase in travel to malarious area without adequate prophylaxis. Cerebral malaria is an encephalopathy, occasionally associated with infestation of P. falciparum, which can complicate some patients infected with Plasmodium falciparum leading to significant mortality. We experienced a case of 45 year-ld male with cerebral malaria, complicated with disseminated intravascular coagulation and acute renal failure. The patient was thought to be infected in travel to Indonesia, Laos, and Bangkok. Blood smear showed typical multiple intra-rythrocytic ring form trophozoites and banana-haped gametocytes of Plasmodium falciparum. The patient died after comatose state with respiration failure for 24 days despite treatment with exchange transfusion, hemodialysis and chemotherapy. We report this case with a review of the literature.
Acute Kidney Injury ; Coma ; Disseminated Intravascular Coagulation ; Drug Therapy ; Humans ; Incidence ; Indonesia ; Korea ; Laos ; Malaria, Cerebral* ; Male ; Mortality ; Plasmodium falciparum* ; Plasmodium* ; Renal Dialysis ; Renal Insufficiency* ; Respiration ; Trophozoites

In recent years, the incidence of imported cases infested with Plasmodium falciparum has been increasing in Korea due to marked increase in travel to malarious area without adequate prophylaxis. Cerebral malaria is an encephalopathy, occasionally associated with infestation of P. falciparum, which can complicate some patients infected with Plasmodium falciparum leading to significant mortality. We experienced a case of 45 year-ld male with cerebral malaria, complicated with disseminated intravascular coagulation and acute renal failure. The patient was thought to be infected in travel to Indonesia, Laos, and Bangkok. Blood smear showed typical multiple intra-rythrocytic ring form trophozoites and banana-haped gametocytes of Plasmodium falciparum. The patient died after comatose state with respiration failure for 24 days despite treatment with exchange transfusion, hemodialysis and chemotherapy. We report this case with a review of the literature.
Acute Kidney Injury ; Coma ; Disseminated Intravascular Coagulation ; Drug Therapy ; Humans ; Incidence ; Indonesia ; Korea ; Laos ; Malaria, Cerebral* ; Male ; Mortality ; Plasmodium falciparum* ; Plasmodium* ; Renal Dialysis ; Renal Insufficiency* ; Respiration ; Trophozoites

OBJECTIVETo study the prognostic significance of coagulation disorders in children with hemophagocytic syndrome (HPS).

METHODSThirty-five children with HPS were retrospectively studied to analyze the etiology, clinical characteristics, laboratory results and treatment outcomes.

RESULTSAfter treatment, 27 of the 35 HPS patients survived, and the other 8 cases died. All cases were treated according to the HLH-2004 protocol, but etoposide (VP-16) was not used in 10 of them. The response rate in patients who received VP-16 (22/25, 88%) was significantly higher than that in those not receiving VP-16 (5/10, 50%) (P<0.05). Compared with the survival group, the dead group had significantly lower platelet count, fibrinogen level, and VP-16 utilization rate (P<0.05) but significantly longer activated partial thromboplastin time and prothrombin time (P<0.05).

CONCLUSIONSCoagulation function can be used as an indicator of disease outcome. It is essential for improving the clinical outcome of HPS to monitor the coagulation function during treatment, detect and correct abnormalities in time, and provide treatment strictly according to the HLH-2004 protocol.

Adolescent ; Child ; Child, Preschool ; Disseminated Intravascular Coagulation ; mortality ; Etoposide ; therapeutic use ; Female ; Humans ; Infant ; Lymphohistiocytosis, Hemophagocytic ; blood ; complications ; drug therapy ; mortality ; Male ; Prognosis ; Retrospective Studies