In the past decade the phenomenon of disseminated intravascular coagulation has gained increasing prominence in the discussion of disease states familiar to the surgeon. This review was prompted by the emergence of new tests to diagnose the condition, by a growing controversy over the significance of certain laboratory abnormalities suggesting its presence, and by an even more difficult dilemma concerning therapy. Since several recent comprehensive reviews of the subject are available,1-6 only those aspects of particular interest to the surgeon will be considered here. Following a brief treatment of the pathophysiology of intravascular coagulation, we deal with the more clinical aspects of the condition.
Normal Events in Coagulation: Definition of Disseminated Coagulation
Gelation of fibrinogen, the visible manifestation of clotting blood, is the end result of a complex series of enzymatic events. The penultimate step is the formation of the potent proteolytic enzyme, thrombin, which cleaves the fibrinogen molecule.