Abstract
That diffuse intravascular coagulation (DIG) occurs in septicemia has been well documented and reported ot occur almost exclusively in patients with hypotension. Heparin has been shown to effectively correct this coagulation defect but the efficacy of this agent in changing the high mortality rate in this group of patients has not been reported. The purposes of this investigation were to determine the frequency of DIC and to evaluate the effect of anticoagulation on the mortality rate in this group. Twenty-six children with septicimia and systolic blood pressures below 80 mm Hg had detailed coagulation studies performed and 24 were anticoagulated with heparin. Therapy also consisted of antibiotics, plasma expanders, IV fluids, transfusions and Isuprcl. Two patients were given corticosteroids. No complications secondary to heparin occured. The studies showed that all patients had abnormally long partial thromboplastin and prothrombin times, and all but one had thrombocytopenia. classical DIC (thrombocytopenia with reduced factors II, V, VIII and fibrinogen, positive fibrin split products and normal euglobulin lysis time) was clearly present in 40% and highly probable in 96% of the cases. The overall mortality rate was 62%. Although 72% of the fatal cases had severe hypofibrinogenemia as compared to 25% who eventually survived, no correlation could be shown between the severity of the DIC and the mortality rate. These data again suggest that most, if not all, patients with sepsis and low blood pressure have DIC. Even though anticoagulation could correct the coagulation defect in most of the cases, heparin did not appear to significantly affect the mortality rate.
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Corrigan, J., Jordan, C. Effect of Heparin on Mortality Rate in Septicemia with Associated Diffuse Intravascular Coagulation. Pediatr Res 4, 464 (1970). https://doi.org/10.1203/00006450-197009000-00121
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DOI: https://doi.org/10.1203/00006450-197009000-00121