Increased plasma levels of tissue factor pathway inhibitor-activated factor X complex in patients with disseminated intravascular coagulation

Plasma levels of tissue factor pathway inhibitor (TFPI)-activated factor Xa (FXa) complex were measured in patients with disseminated intravascular coagulation (DIC), pre-DIG, and DIG. Plasma levels of plasmin-plasmin inhibitor complex (PPIC), D-dimer, and soluble fibrin monomer (SFM) were significantly higher in patients with DIG than in those with pre-DIG or non-DIG; the levels of these hemostatic markers were significantly higher in patients with pre-DIG than in those with non-DIG. Plasma levels of thrombin-antithrombin complex (TAT) were significantly higher in patients with DIG or pre-DIG than in those with non-DIG. Plasma levels of tissue factor (TF), total TFPI, free TFPI, and TFPI-Xa complex were significantly higher in patients with DIG than in those with non-DIC. Plasma levels of TFPI-Xa complex were significantly increased in patients with pre-DIG as compared to those with non-DIG; however, plasma free TFPI levels were significantly decreased in patients with pre-DIG as compared to those with non-DIG. These findings suggest that free TFPI might be consumed in the pre-DIG state, thereby confirming the activation of the extrinsic pathway. Plasma levels of TFPI-Xa complex were significantly correlated with TF, free TFPI, and total TFPI. Increased plasma TFPI-Xa complex levels might be useful for the diagnosis of DIG or pre-DIG, particularly that occurring by activation of the extrinsic pathway of blood coagulation. (C) 2000 Wiley-Liss, Inc.