{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T18:56:23Z","timestamp":1791312983033,"version":"4.3.1"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2009,12,9]],"date-time":"2009-12-09T00:00:00Z","timestamp":1260316800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2010,2]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p><jats:bold>Objective\u2002<\/jats:bold> To determine the involvement of coagulation in bleeding and poor outcome in patients with severe leptospirosis.<\/jats:p><jats:p><jats:bold>Methods\u2002<\/jats:bold> In a prospective study, parameters of the coagulation system were measured on admission and during follow\u2010up in 52 consecutive patients with severe leptospirosis.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> All patients showed coagulation disorders, such as prolonged prothrombin time (PT) and activated partial thromboplastin time, marked procoagulant activity [thrombin\u2013antithrombin (TAT) complexes, prothrombin fragment 1+2, D\u2010dimer], reduced levels of anticoagulant markers (protein C, antithrombin) and increased (anti\u2010) fibrinolytic activity [plasmin\u2013antiplasmin (PAP) complexes, plasminogen activator inhibitor\u20101]. These disorders were more pronounced in patients who died eventually. PT prolongation was associated with mortality (OR 1.4, 95% CI: 1.0\u20131.8, <jats:italic>P<\/jats:italic>\u2003=\u20030.04). Bleeding occurred in 31 subjects (60%). Of these, 24 had mild bleeding and seven had severe haemorrhages. Thrombocytopenia (platelets \u2264100\u2003\u00d7\u200310<jats:sup>9<\/jats:sup>\/l) was significantly associated with clinical bleeding (OR 4.6, 95% CI: 1.3\u201316). A subanalysis of patients with and without severe bleeding revealed a more pronounced imbalance of the coagulation system in patients with severe bleeding, as reflected by a significant association with PT (OR 1.4, 95% CI: 1.0\u20131.8, <jats:italic>P<\/jats:italic>\u2003=\u20030.05) and the TAT\/PAP ratio (OR 1.3, 95% CI: 1.0\u20131.6, <jats:italic>P<\/jats:italic>\u2003=\u20030.05), which is an indicator of the balance between coagulation and fibrinolysis. Overt disseminated intravascular coagulation (DIC) was found in 10 (22%) of the 46 patients for whom the score could be calculated. There was no significant association between DIC scores, bleeding diathesis or poor outcome.<\/jats:p><jats:p><jats:bold>Conclusion\u2002<\/jats:bold> The coagulation system was strongly activated in patients with leptospirosis. This was more pronounced in the deceased and in patients with severe bleeding than in than the survivors and in those without severe bleeding.<\/jats:p>","DOI":"10.1111\/j.1365-3156.2009.02434.x","type":"journal-article","created":{"date-parts":[[2010,1,13]],"date-time":"2010-01-13T01:20:18Z","timestamp":1263345618000},"page":"152-159","source":"Crossref","is-referenced-by-count":73,"title":["Coagulation disorders in patients with severe leptospirosis are associated with severe bleeding and mortality"],"prefix":"10.1111","volume":"15","author":[{"given":"J. F. P.","family":"Wagenaar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. G. A.","family":"Goris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. L.","family":"Partiningrum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Isbandrio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. A.","family":"Hartskeerl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. P. M.","family":"Brandjes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. C. M.","family":"Meijers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. H.","family":"Gasem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. C. M.","family":"Van Gorp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2010,1,12]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199206000-00025"},{"key":"e_1_2_7_3_1","first-page":"393","article-title":"The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil\u2019s disease)","volume":"40","author":"Arean VM","year":"1962","journal-title":"American Journal of Pathology"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1086\/524664"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0036-46652002000200006"},{"key":"e_1_2_7_6_1","doi-asserted-by":"crossref","first-page":"827","DOI":"10.4269\/ajtmh.1982.31.827","article-title":"Thrombocytopenia in leptospirosis","volume":"31","author":"Edwards CN","year":"1982","journal-title":"American Journal of Tropical Medicine and Hygiene"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.1986.35.352"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.10137"},{"key":"e_1_2_7_9_1","first-page":"174","article-title":"The pathogenesis of leptospirosis I. Hemorrhages in experimental leptospirosis in guinea pigs","volume":"41","author":"Higgins R","year":"1977","journal-title":"Canadian Journal of Comparative Medicine"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1086\/320723"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc2459"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2002.67.278"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.14.2.296-326.2001"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc4975"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc2816"},{"key":"e_1_2_7_16_1","first-page":"70","article-title":"In vitro effect of Leptospira icterohaemorrhagiae on human mononuclear leukocytes procoagulant activity: comparison of virulent with nonvirulent strain","volume":"47","author":"Miragliotta G","year":"1983","journal-title":"Canadian Journal of Comparative Medicine"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9440(10)63198-7"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0036-46651990000400004"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0037-86821995000300002"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1189\/jlb.0607373"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.1980.95"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2007.02313.x"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/147323000203000511"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2006.01792.x"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-6-19"}],"container-title":["Tropical Medicine &amp; International Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1365-3156.2009.02434.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1365-3156.2009.02434.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,14]],"date-time":"2023-10-14T04:26:34Z","timestamp":1697257594000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-3156.2009.02434.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2010,1,12]]},"references-count":24,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2010,2]]}},"alternative-id":["10.1111\/j.1365-3156.2009.02434.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1365-3156.2009.02434.x","archive":["Portico"],"relation":{},"ISSN":["1360-2276","1365-3156"],"issn-type":[{"value":"1360-2276","type":"print"},{"value":"1365-3156","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,1,12]]}}}