Hemostatic molecular markers before the onset of disseminated intravascular coagulation

We retrospectively measured various hemostatic markers in 240 patients with disseminated intravascular coagulation (DIG) before the onset of DIC and in 110 non-DIG patients, and examined their usefulness for the diagnosis of pre-DIG. Changes in prothrombin time ratio and fibrinogen levels were not significant before the onset of DIG. The plasma levels of fibrinogen and fibrin degradation products before the onset of DIC were increased and the platelet count was gradually reduced in nonleukemic patients; these changes were already significant in the non-DIG state. The plasma levels of thrombin-antithrombin complex (TAT), plasmin-plasmin inhibitor complex (PPIC), D-dimer, and soluble fibrin monomer (sFM) were increased before the onset of DIG. In leukemic patients, the plasma levels of sFM on day 5, those of TAT on day 3, and D-dimer on day 1, were significantly increased before the onset of DIG. The levels of most hemostatic markers 7 days before the onset of DIG were not different from those observed in the non-DIG state. In nonleukemic patients, only D-dimer, sFM, and TAT levels were significantly increased 1 days before the onset of DIC compared with values in the non-DIG state, The positive rate of hemostatic markers for the diagnosis of DIG, TAT, and PPIC were high during the pre-DIG and non-DIG groups. The plasma levels of sFM and D-dimer were low in non-DIG and increased gradually during the pre-DIG state, These findings suggest that hemostatic molecular markers such as sFM, D-dimer, and TAT are useful for the diagnosis of pre-DIG, although their cutoff values were different among various diseases. Am. J. Hematol. 60:273-278, 1999. (C) 1999 Wiley-Liss, Inc.