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Coagulation in sepsis

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Abstract

Coagulation abnormalities, ranging from a simple fall in platelet count to full-blown disseminated intravascular coagulation, are a common occurrence in critically ill patients and have been associated with increased mortality. In sepsis, activation of the extrinsic coagulation pathway by tissue factor induces increased coagulation, and simultaneous depression of the inhibitory mechanisms of coagulation, and suppression of the fibrinolytic system results in a procoagulant state that may lead to the formation of microvascular thrombi disturbing organ microcirculation and promoting the development of organ dysfunction. Many inflammatory mediators are involved in the activation of coagulation, but many coagulation proteins are themselves actively involved in the inflammatory process. In this article, we explore the complex relationship between inflammation and coagulation and how improved understanding of this interaction has led to the development of new therapeutic agents for patients with severe sepsis.

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Authors and Affiliations

  1. Dept of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium

    André Amaral & Jean-Louis Vincent

  2. Dept of Infectious Diseases, Memorial Hospital, Pawtucket, USA

    Steven M. Opal

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  1. André Amaral
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  2. Steven M. Opal
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  3. Jean-Louis Vincent
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Correspondence to Jean-Louis Vincent.

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Competing interests: Dr SM Opal and Dr JL Vincent have been consultants for, and have received honorariums from, Aventis (antithrombin), Eli Lilly [drotrecogin alfa (activated)], and Chiron (tissue factor pathway inhibitor). Dr JL Vincent was the Principal Investigator of the European arm of the PROWESS study and principal investigator of the ENHANCE study (Eli Lilly) and an investigator for the TFPI study (Chiron). Dr Opal was the principal investigator for the Kybersept trial (Aventis), and was one of the North American investigators in the TFPI trial

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Amaral, A., Opal, S.M. & Vincent, JL. Coagulation in sepsis. Intensive Care Med 30, 1032–1040 (2004). https://doi.org/10.1007/s00134-004-2291-8

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