Rationale for restoration of physiological anticoagulant pathways in patients with sepsis and disseminated intravascular coagulation.

Abstract:

OBJECTIVE:In the pathogenesis of disseminated intravascular coagulation, dysfunctional natural anticoagulant pathways appear to play a pivotal role. In this article, we will address the mechanisms that contribute to this defect in the regulation of coagulation activation. Furthermore, we will explore the experimental and clinical evidence that restoration of these anticoagulant pathways results in clinical improvement. DATA SOURCES:We have searched and reviewed published articles on experimental studies of disseminated intravascular coagulation models in animals and clinical studies in patients with disseminated intravascular coagulation. DATA SYNTHESIS:All three major anticoagulant pathways, that is, the antithrombin pathway, the protein C system, and tissue factor pathway inhibitor, are defective in sepsis and disseminated intravascular coagulation. Several mechanisms contribute to this defect. Restoration of these pathways, in principle, by administration of coagulation inhibitor concentrates or recombinant anticoagulant factors, appears to ameliorate the coagulation disorder and, more important, result in improvement of clinically relevant outcomes, such as a reduction of organ failure and mortality. CONCLUSIONS:Restoration of disrupted physiologic anticoagulant pathways in disseminated intravascular coagulation is not only a logical point of impact in patients with sepsis and an activated coagulation system, but also is associated with an improved outcome in experimental and (initial) clinical studies.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Levi M,de Jonge E,van der Poll T

doi

10.1097/00003246-200107001-00028

subject

Has Abstract

pub_date

2001-07-01 00:00:00

pages

S90-4

issue

7 Suppl

eissn

0090-3493

issn

1530-0293

journal_volume

29

pub_type

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