Coagulation inhibitors in sepsis and disseminated intravascular coagulation.
Sepsis is a syndrome that is increasing in frequency and continues to be associated with an unacceptably high mortality. DIC is an important and common sequel of sepsis, is implicated in the development of multiple organ failure, and has been shown repeatedly to connote a poor prognosis. Increasing understanding of the pathogenesis of DIC has suggested several novel therapies designed to correct deficiencies in inhibitors of coagulation. To date, small randomized, controlled studies of antithrombin III concentrates in sepsis and DIC have shown a trend to increased survival, but have not achieved statistical significance. Currently, a large randomized controlled trial of antithrombin III in sepsis is being conducted. Until more data are available, important questions remain as to its proper place in the treatment of sepsis, septic shock, and DIC. Similarly, therapy with protein C and tissue factor-pathway inhibitor has been beneficial in animal models of sepsis and DIC. The results of controlled clinical trials in humans are eagerly awaited.
Lee
W L
WL
Toronto General Hospital of the University Health Network, Department of Medicine, Ontario, Canada.
Downey
G P
GP
D000818:Animals; D000990:Antithrombin III / Q000378:metabolism / Q000627:therapeutic use*; D019774:Blood Coagulation Factor Inhibitors / Q000378:metabolism; D004211:Disseminated Intravascular Coagulation / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008074:Lipoproteins / Q000627:therapeutic use; D011486:Protein C / Q000627:therapeutic use; D018805:Sepsis / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D015842:Serine Proteinase Inhibitors / Q000378:metabolism / Q000627:therapeutic use*
D019774:Blood Coagulation Factor Inhibitors; D005343:Fibrinolytic Agents; D008074:Lipoproteins; D011486:Protein C; D015842:Serine Proteinase Inhibitors; C051928:lipoprotein-associated coagulation inhibitor; D000990:Antithrombin III