• J F P Wagenaar, M G A Goris, D L Partiningrum, B Isbandrio, R A Hartskeerl, D P M Brandjes, J C M Meijers, M H Gasem, and E C M van Gorp.
• Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands. jfpwagenaar@hotmail.com
• Trop. Med. Int. Health. 2010 Feb 1; 15 (2): 152-9.

ObjectiveTo determine the involvement of coagulation in bleeding and poor outcome in patients with severe leptospirosis.MethodsIn a prospective study, parameters of the coagulation system were measured on admission and during follow-up in 52 consecutive patients with severe leptospirosis.ResultsAll patients showed coagulation disorders, such as prolonged prothrombin time (PT) and activated partial thromboplastin time, marked procoagulant activity [thrombin-antithrombin (TAT) complexes, prothrombin fragment 1+2, D-dimer], reduced levels of anticoagulant markers (protein C, antithrombin) and increased (anti-) fibrinolytic activity [plasmin-antiplasmin (PAP) complexes, plasminogen activator inhibitor-1]. These disorders were more pronounced in patients who died eventually. PT prolongation was associated with mortality (OR 1.4, 95% CI: 1.0-1.8, P = 0.04). Bleeding occurred in 31 subjects (60%). Of these, 24 had mild bleeding and seven had severe haemorrhages. Thrombocytopenia (platelets ConclusionThe 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.

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