Disseminated Intravascular Coagulation in Anaphylaxis

The dynamics of thrombolysis over time in acute immunologic reactions

Allergic reactions and angioedema are important immunologic conditions in acute care settings. Prior data indicate an association between symptom severity and maximum lysis (ML) in thromboelastometry. We aimed to evaluate the dynamics of ML two hours after admission to the emergency department. We determined ML with thromboelastometry using extrinsic testing (EXTEM, ROTEM®, Werfen GmbH, Munich, Germany) at the presentation of patients with immunologic reactions and approximately two hours thereafter (after the observation interval). The median test was used to compare the extent of ML between individuals who were still symptomatic after the observation interval and those who were asymptomatic. We prospectively enrolled 16 individuals (10 (63%) female, mean age 50 ± 14 years). Of these, 6 (38%) were still symptomatic after the observation interval. These patients at that time had significantly higher ML than those who were asymptomatic (14% (IQR 12-17) vs. 8% (IQR 4-10), p = 0.002). To conclude, in emergency department patients with immunologic reactions, symptoms after 2 h of observation may be associated with alterations in ML.