Disseminated Intravascular Coagulation (DIC) The DIC process can be divided into three stages: • Hypercoagulable (Stage I) • Secondary fibrinolytic (Stage II) • Hypocoagulable (Stage III) Hypercoagulable (Stage I) DIC is commonly initiated through release of tissue factor (TF) and FVIIa activation of the extrinsic pathway, resulting in a deposition of thrombin in the microcirculation system. TF is normally contained within the cellular membrane and encrypted. However, traumatic tissue injury, required major resuscitation, or major surgery, exposes TF to the bloodstream. TF expression can also occur when monocytes are activated by sepsis, endotoxin, the presence of cancerous cells, or in pregnancy when amniotic fluid penetrates the maternal blood stream. In summary, the release of TF, together with FVIIa, initiates the extrinsic coagulation cascade and, if it is not anticoagulated accordingly, with heparin low molecular weight heparin (LMWH), or activated protein C ...
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