Hemostatic molecular markers before onset of disseminated intravascular coagulation in leukemic patients.

The changes in various hemostatic parameters were examined within a period from 7 days before the onset of disseminated intravascular coagulation (DIC) in 114 patients (i.e. in their pre-DIC state). The changes in prothrombin time (PT) ratio and fibrinogen levels were not significant before the onset of DIC. Plasma fibrinogen and fibrin degradation products (FDP) levels before the onset of DIC were high, but these changes were already significant in 110 non-DIC patients examined. Plasma thrombin-antithrombin complex (TAT), plasmin-plasmin inhibitor complex (PPIC), D-dimer and soluble fibrin monomer (SFM) levels were high before the onset of DIC. In the 110 leukemic DIC patients, the plasma SFM levels were significantly increased 5 days before, the plasma TAT levels were significantly increased 3 days before, and the D-dimer levels were significantly increased 1 day before the onset of DIC. The plasma tissue factor and plasminogen activator inhibitor-I levels were not significantly changed before the onset of DIC. The PT ratio, fibrinogen, FDP, platelet count, antithrombin, D-dimer, and PPIC levels at 7 days before the onset of DIC were not significantly different from the corresponding values in the non-DIC group, although the hemostatic molecular markers SFM, D-dimer, and TAT are useful for the diagnosis of pre-DIC. Plasma thrombomodulin levels were significantly increased in these patients who died, and plasma antithrombin and protein C activities markedly reduced in the patients who died. The outcome of the diseases underlying DIC is related to vascular endothelial cell injuries.