Disseminated intravascular coagulation in sepsis.
Disseminated intravascular coagulation is a frequent complication of sepsis. Coagulation activation, inhibition of fibrinolysis, and consumption of coagulation inhibitors lead to a procoagulant state resulting in inadequate fibrin removal and fibrin deposition in the microvasculature. As a consequence, microvascular thrombosis contributes to promotion of organ dysfunction. Recently, three randomized, double-blind, placebo-controlled trials investigated the efficacy of antithrombin, activated protein C (APC), and tissue factor pathway inhibitor, respectively, in sepsis patients. A significant reduction in mortality was demonstrated in the APC trial. In this article, we first discuss the physiology of coagulation and fibrinolysis activation. Then, the pathophysiology of coagulation activation, consumption of coagulation inhibitors, and the inhibition of fibrinolysis leading to a procoagulant state are described in more detail. Moreover, therapeutic concepts as well as the three randomized, double-blind, placebo-controlled studies are discussed.
Zeerleder
Sacha
S
Central Hematology Laboratory, University Hospital, Berne, Switzerland.
Hack
C Erik
CE
Wuillemin
Walter A
WA
D000925:Anticoagulants / Q000627:therapeutic use; D004211:Disseminated Intravascular Coagulation / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D018805:Sepsis / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology
D000925:Anticoagulants; D005343:Fibrinolytic Agents