Low levels of coagulation inhibitors in patients with Clostridium difficile infection

Clostridium difficile Induced Inflammasome Activation and Coagulation Derangements

C. difficile enterocolitis (CDAC) is the most common hospital infection, burdened by an increased incidence of coagulation-related complications such as deep vein thrombosis (DVT) and disseminated intravascular coagulation (DIC) as well as a significant sepsis-related mortality. In this review, we analyzed the available data concerning the correlation between coagulation complications related to C. difficile infection (CDI) and inflammasome activation, in particular the pyrin-dependent one. The little but solid available preclinical and clinical evidence shows that inflammasome activation increases the risk of venous thromboembolism (VTE). As proof of this, it has been observed that in vitro inhibition of the molecules (e.g., tissue factor) mainly involved in coagulation activation could block the process. In vivo studies show that it could be possible to reduce the incidence of complications associated with C. difficile infection (CDI) and mortality due to a state of hypercoagulability. A personalized therapeutic approach to reduce the inflammatory activity and prevent thromboembolic complications could be preliminarily defined to reduce mortality.

Prevention and treatment of thrombosis, phlebitis, and laminitis in horses with gastrointestinal diseases

Organ thrombosis and laminitis are life-threatening complications in horses with acute gastrointestinal disease, especially those diseases that cause disruption of the protective mucosal barrier. Prevention of these complications should be a high priority when treating horses with gastrointestinal diseases because even with proper and intensive treatments, laminitis or organ thrombosis may not be curative. Preventative therapy should include expedient and appropriate treatment of the primary disease, normalization of tissue perfusion and oxygenation, and inhibition of gut-derived toxins or their systemically activated biologic products along with i.v. replacement of depleted anticoagulant proteins. Additionally, several risk factors for thrombophlebitis in horses with intestinal disease have been identified, and those risk factors should be minimized during the illness.