INTRAVASCULAR COAGULATION IN SURGICAL PATIENT - ITS SIGNIFICANCE AND DIAGNOSIS

The role of disseminated intravascular coagulation (DIC) in a series of twelve patients in whom unexplained bleeding developed during or after a surgical procedure was investigated. The patients were operated on for severe, traumatic, life-threatening surgical diseases. The over-all mortality was 83 per cent and the morbidity 100 per cent. Hemorrhagic manifestations ranged from a troublesome ooze at the suture line or venipuncture sites to massive bleeding at the site of operation. It occurred both during and after the operative procedure. The total number of transfusions varied from ten to sixty-three per patient. Hypoxemia was present in 74 per cent and ozotemia in 83 per cent. Sepsis was a frequent and major complication and was responsible for all the late deaths; the organisms were predominantly gram-negative. Hemostatic tests showed thrombocytopenia in 92 per cent, fibrinogenopenia in 58 per cent, and plasminogenopenia in 72 per cent. There was a reduction of one stage prothrombin activity in 91 per cent and of specific clotting factors as follows: factor II 83 per cent, V 82 per cent, VII 92 per cent, VIII 66 per cent, IX 54 per cent, and X 75 per cent. Fibrin degradation products were present in 90 per cent. Postmortem examination in eight patients showed macrothromboemboli, microthromboemboli, or both in four. Bronchopneumonia was common and there was a high incidence of acute tubular necrosis of the kidneys. Five patients received heparin; all died within fortyeight hours of nonhemorrhagic complications. The bleeding disorder was improved in two patients and was not made worse in the other three. One patient received epsilon-aminocaproic acid without improvement. It was concluded that DIC is a common factor responsible for much of the morbidity and mortality in patients requiring surgery for trauma or other life-threatening emergencies in which shock is a factor. It should be suspected on clinical grounds when hemostatic, respiratory, and/or renal failure occur in the immediate postoperative period. Heparin is the therapy of choice but requires courage to administer when the possibility of inadequate surgical hemostasis exists. © 1969.