title: Link between coagulation abnormalities and microcirculatory dysfunction in critically ill patients.
abstract: OBJECTIVE
  The current review discusses the role of coagulation in microcirculatory abnormalities and whether anticoagulants may improve microvascular perfusion.
  
  
  RESULTS
  Microvascular alterations frequently occur in sepsis and ischemia-reperfusion injury. These alterations are due to endothelial dysfunction and interaction of endothelium and circulating cells. Although the activation of coagulation has been extensively shown to occur in these conditions, microthrombosis seems not to be a predominant factor. Nevertheless, the interplay between coagulation, inflammation and the endothelium seems to favor microvascular dysfunction. Several agents with anticoagulant properties, especially activated protein C and antithrombin, improve the diseased microcirculation, but these agents have pleiotropic effects, and it seems unlikely that these beneficial effects are linked to direct inhibition of coagulation. Current evidence does not support the use of pure anticoagulant agents to improve microvascular perfusion.
  
  
  CONCLUSIONS
  The activation of coagulation may play an indirect role in microvascular dysfunction, through interplay with endothelium and inflammation.
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. ddebacke@ulb.ac.be
authors.forename: Daniel
authors.initials: D
authors.lastname: De Backer
authors.forename: Katia
authors.initials: K
authors.lastname: Donadello
authors.forename: Raphaël
authors.initials: R
authors.lastname: Favory
mesh_terms: D000925:Anticoagulants / Q000494:pharmacology; D001777:Blood Coagulation / Q000187:drug effects / Q000502:physiology*; D001778:Blood Coagulation Disorders / Q000503:physiopathology*; D016638:Critical Illness; D004730:Endothelium, Vascular / Q000503:physiopathology*; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D008833:Microcirculation / Q000187:drug effects
chemical_list: D000925:Anticoagulants