Clinical impact of novel anticoagulation strategies in sepsis.
Derangements in coagulation and fibrinolysis are frequent complications of systemic infection, and septic shock is the most common recognized cause of disseminated intravascular coagulation. Anticoagulant therapy has been used as a treatment strategy for severe sepsis for several decades without compelling evidence of efficacy until the 2001 publication of the phase III trial with recombinant human activated protein C. Major phase III international trials with antithrombin and tissue factor pathway inhibitor also have been completed recently. The molecular mechanisms by which the clotting system interacts with the innate immune response have greatly facilitated the understanding of coagulation and the pathophysiology of septic shock. Anticoagulants such as recombinant human activated protein C and related agents may become the mainstay of adjuvant therapies for severe sepsis in the near future.
Opal
S M
SM
Brown University School of Medicine, and Director, Infectious Disease Division, Memorial Hospital of Rhode Island, Pawtucket 02860, Rhode Island, USA. Steven_Opal@brown.edu
D000925:Anticoagulants / Q000627:therapeutic use*; D017326:Clinical Trials, Phase III as Topic; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D011486:Protein C / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D018805:Sepsis / Q000188:drug therapy*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D011486:Protein C; D011994:Recombinant Proteins