Severe sepsis, coagulation, and fibrinolysis: dead end or one way?
It was suggested more than 30 yrs ago that inhibition of the clotting cascade by natural anticoagulants could decrease the high mortality observed in patients suffering from severe sepsis and septic shock. Unfortunately, this therapeutic "paradigm" has led to a dead end, illustrated by the failure of all randomized trials and the recent withdrawal of recombinant activated protein C. Should we now definitely give up trying to treat septic coagulation disturbances or is there any therapeutic alternative?
Département Universitaire de Réanimation, Université de Lille 2, Service de Réanimation polyvalente, Hôpital Roger Salengro, CHRU de Lille, France. francois.fourrier@chru-lille.fr
François
F
Fourrier
D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005342:Fibrinolysis / Q000502:physiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011486:Protein C / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D012772:Shock, Septic / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D016019:Survival Analysis; D017211:Treatment Failure
D000925:Anticoagulants; D011486:Protein C