Coagulopathy in severe acute pancreatitis: pathogenesis and potential correction methods: 616.37-002:616.151.511
Тромбоз, гемостаз и реология

Tromboz, Gemostaz I Reologiya
scientific and practical journal

ISSN 2078–1008 (Print); ISSN 2687-1483 (online)

Keywords

pancreatitis
blood coagulation disorders
inflammation
heparin
warfarin
hemofiltration

Abstract

Summury. One of the actual problems in acute pancreatitis treatment is blood coagulation disorders, leading to both throm- boembolic complications and disseminated intravascular coagulation. This article summarizes the current concepts of blood coagulation disorders in acute pancreatitis. Systemic inflammation response leads to complex blood coagulation disorder repre- senting in thrombocyte count and function change, hypercoagulation, and secondary hyperfibrinolysis. Anticoagulation system is not effective in hypercoagulation prevention in these settings. Components of both coagulation and anticoagulation systems are considered as therapeutic targets of blood coagulation disorders treatment in acute pancreatitis.

References:

  1. Petrov M.S., Yadav D. Global epidemiology and holistic prevention of pancreatitis. Nat Rev Gastroenterol Hepatol. 2019;16(3):175–84. DOI: 10.1038/s41575–018–0087–5.
  2. Samigulina G.R., Spiridonova E.A., Roitman E.V. et al. Hemosta- sis differences in survived and died patients in the early stage of acute necrotizing pancreatitis. Gematologiya i transfuziologiya. 2016;61(2):92–6. (In Russ.). DOI: 10.18821/0234–5730–2016–61– 2–92–96.
  1. Chung W.S., Lin C.L. Association between venous thromboembolism and acute pancreatitis: An analysis from the nationwide inpatient sample. Clin Respir J. 2020;14(4):320–7. DOI: 10.1111/crj.13134.
  2. Maduzia D., Ceranowicz P., Cieszkowski J. et al. Administration of warfarin accelerates the recovery in ischemia/reperfusion- induced acute pancreatitis. J Physiol Pharmacol. 2020;71(3):417– 27. DOI: 10.26402/jpp.2020.3.13.
  3. Dumnicka P., Maduzia D., Ceranowicz P. et al. The interplay between inflammation, coagulation and endothelial injury in the early phase of acute pancreatitis: clinical implications. Int J Mol Sci. 2017;18(2):354. DOI: 10.3390/ijms18020354.
  4. Garg P.K.,SinghV.P.Organfailureduetosystemicinjuryinacute pancreatitis. Gastroenterology. 2019;156(7):2008–23. DOI: 10.1053/j.gastro.2018.12.041.
  5. Levi M., Sivapalaratnam S. Disseminated intravascular coagulation: an update on pathogenesis and diagnosis. Expert Rev Hematol. 2018;11(8):663–72. DOI: 10.1080/17474086.2018.1500173.
  6. Witkowski M., Landmesser U., Rauch U. Tissue factor as a link between inflammation and coagulation. Trends Cardiovasc Med. 
2016;26(4):297–303. DOI: 10.1016/j.tcm.2015.12.001. 

  7. Kakafika A., Papadopoulos V., Mimidis K., Mikhailidis D.P. Coagu- lation, platelets, and acute pancreatitis. Pancreas. 2007;34(1):15– 
 DOI: 10.1097/01.mpa.0000240617.66215.d2. 

  8. Ou Z.B., Miao C.M., Ye M.X. et al. Investigation for role of tissue 
factor and blood coagulation system in severe acute pancreatitis and associated liver injury. Biomed Pharmacother. 2017;85:380– 8. DOI: 10.1016/j.biopha.2016.11.039. 

  9. Signoretti M., Roggiolani R., Stornello C. et al. Gut microbiota and pancreatic diseases. Minerva Gastroenterol Dietol. 2017;63(4):399– DOI: 10.23736/S1121–421X.17.02387-X. 

  10. Bonavia A., Groff A., Karamchandani K., Singbartl K. Clinical utility of extracorporeal cytokine hemoadsorption therapy: A literature Blood Purif. 2018;46(4):337–49. DOI: 10.1159/000492379. 

  11. Hu Y., Xiong W., Li C., Cui Y. Continuous blood purification for severe acute pancreatitis: A systematic review and meta-ana- lysis. Medicine (Baltimore). 2019;98(12):e14873. DOI: 10.1097/ MD.0000000000014873. 

  12. Foley J.H., Conway E.M. Cross talk pathways between coagulation and inflammation. Circ Res. 2016;118(9):1392–408. DOI: 10.1161/ CIRCRESAHA.116.306853. 

  13. Zaidi A., Green L. Physiology of haemostasis. Anaesth Intensive Care. 2019;20(3): 152–8. DOI: 10.1016/j.mpaic.2019.01.005. 

  14. Huntington J. A. Serpin structure, function and dysfunc- tion. J Thromb Haemost. 2011;9(1):26–34. DOI: 10.1111/j.1538– 7836.2011.04360.x.
  15. 
Dzharar R.M., Korymasov E.A., Gorbunov Yu.V. Correction of hemostasis in the treatment of the early stage of acute pancre- atitis. Novosti hirurgii. 2011;19(2):43–9. (In Russ.). 

  16. Samigulina G.R., Spiridonova E.A., Roitman E.V. et al. Analysis of procoagulant, anticoagulant and fibrinolytic blood activity in the early stages of acute destructive pancreatitis. Vestnik intensivnoj terapii. 2014;(1):40–4 (In Russ.). 

  17. Gando S., Levi M., Toh C.H. Disseminated intravascular coagula- Nat Rev Dis Primers. 2016;2:16037. DOI: 10.1038/nrdp.2016.37. 

  18. Kyhälä L., Lindström O., Kylänpää L. et al. Activated pro- tein C retards recovery from coagulopathy in severe acute pancreatitis. Scand J Clin Lab Invest. 2016;76(1):10–6. DOI: 
3109/00365513.2015.1084041. 

  19. Liu C., Zhou X., Ling L. et al. Prediction of mortality and organ 
failure based on coagulation and fibrinolysis markers in patients with acute pancreatitis: A retrospective study. Medicine (Balti- more). 2019;98(21):e15648. DOI: 10.1097/MD.0000000000015648. 

  20. Yang N., Zhang D.L., Hao J.Y. Coagulopathy and the prognostic potential of D-dimer in hyperlipidemia-induced acute pancreati- tis. Hepatobiliary Pancreat Dis Int. 2015;14(6):633–41. DOI: 10.1016/ s1499–3872(15)60376–9. 

  21. Ahmed S.U., Rana S.S., Ahluwalia J. et al. Role of thrombophilia in splanchnic venous thrombosis in acute pancreatitis. Ann Gas- troenterol. 2018;31(3):371–8. DOI: 10.20524/aog.2018.0242. 

  22. Yang N., Hao J., Zhang D. Antithrombin III and D-dimer levels as indicators of disease severity in patients with hyperlipidaemic or biliary acute pancreatitis. J Int Med Res. 2017;45(1):147–58. DOI: 1177/0300060516677929. 

  23. Fidan S., Erkut M., Cosar A.M. et al. Higher thrombin-antithrombin III complex levels may indicate severe acute pancreatitis. Dig Dis. 2018;36(3):244–51. DOI: 10.1159/000485613.
  24. Maeda K., Hirota M., Ichihara A. et al. Applicability of dissemi- nated intravascular coagulation parameters in the assessment of the severity of acute pancreatitis. Pancreas. 2006;32(1):87–92. DOI: 10.1097/01.mpa.0000186248.89081.44.
  25. Yano T., Taniguchi M., Shirasaka T., Tsuneyoshi I. Effectiveness of soluble pecombinant human thrombomodulin in patients with severe acute pancreatitis complicated by disseminated intravas- cular coagulation. Turk J Anaesthesiol Reanim. 2019;47(4):320–6. DOI: 10.5152/TJAR.2019.42709.
  26. Hagiwara S., Iwasaka H., Shingu C. et al. Antithrombin III pre- vents cerulein-induced acute pancreatitis in rats. Pancreas. 2009;38(7):746–51. DOI: 10.1097/MPA.0b013e3181aba9fa.
  27. Kambhampati S., Park W., Habtezion A. Pharmacologic therapy for acute pancreatitis. World J Gastroenterol. 2014;20(45):16868– 80. DOI: 10.3748/wjg.v20.i45.16868.
  28. Tozlu M., Kayar Y., İnce A.T. et al. Low molecular weight hepa- rin treatment of acute moderate and severe pancreatitis: A ran- domized, controlled, open-label study. Turk J Gastroenterol. 2019;30(1):81–7. DOI: 10.5152/tjg.2018.18583.
  29. Ai M., Liu L., Lu G., Xu J. Application of continuous regional arterial perfusion of low molecular weight heparin calcium in treating severe acute pancreatitis: Clinical results in 8 patients. J Intervent Radiol. 2019;28(6):533–6. DOI: 10.3969/j.issn.1008– 794X.2019.06.007.
  30. Shankar-Hari M., Wyncoll D. Activated protein C in severe acute pancreatitis without sepsis? Not just yet. Crit Care. 2010;14(4):188. DOI: 10.1186/cc9190.
  31. Sanghvi S., Waqar F., Effat M. Coronary thrombosis in acute pan- creatitis. J Thromb Thrombolysis. 2019;47(1):157–61. DOI: 10.1007/ s11239–018–1741-z.
  32. Ke L., Ni H.B., Tong Z.H. et al. D-dimer as a marker of severity in patients with severe acute pancreatitis. J Hepatobiliary Pancreat Sci. 2012;19(3):259–65. DOI: 10.1007/s00534–011–0414–5.
  33. Gomercic C., Gelsi E., Van Gysel D. et al. Assessment of D-dimers for the early prediction of complications in acute pancreatitis. Pan- creas. 2016;45(7):980–5. DOI: 10.1097/MPA.0000000000000654.
  34. Wan J., Yang X., He W. et al. Serum D-dimer levels at admission for prediction of outcomes in acute pancreatitis. BMC Gastroen- terol. 2019;19(1):67. DOI: 10.1186/s12876–019–0989-x.
  35. Osada J., Wereszczynska-Siemiatkowska U., Dabrowski A., Dab- rowska M.I. Platelet activation in acute pancreatitis. Pancreas. 2012;41(8):1319–24. DOI: 10.1097/MPA.0b013e31824bd89f.
  36. Saif M.W. DIC secondary to acute pancreatitis. Clin Lab Haematol. 2005;27(4):278–82. DOI: 10.1111/j.1365–2257.2005.00697.x.
  37. Chikaev V.F., Aydarov A.R., Zinkevich O.D. et al. Features of plate- let reaction in acute pancreatitis. Kazanskij medicinskij zhurnal. 2017;98(2):172–5. (In Russ.). DOI: 10.17750/KMJ2017–172.
  1. Chen C., Xia S.H., Chen H., Li X.H. Therapy for acute pancreatitis with platelet-activating factor receptor antagonists. World J Gas- troenterol. 2008;14(30):4735–8. DOI: 10.3748/wjg.14.4735.
  2. Sinkov S. V., Roitman E. V., Zabolotskikh I. B. New criteria for sepsis-induced coagulopathy. Review. Vestnik intensivnoj terapii imeni A.I. Saltanova. 2019;(3):52–7. (In Russ.). DOI: 10.21320/1818– 474X-2019–3–52–57.