Pathophysiology and diagnosis of coagulation activation in sepsis

Sepsis can be regarded as a systemic inflammatory reaction often accompanie d by disseminated intravascular coagulation (DIC) which is supposed to be i nitiated by the expression of tissue factor for example by activated monocy tes and endothelial cells. The hallmark of DIC is the intravascular generat ion of thrombin which leads to fibrin formation. Diagnosis of DIC is likely if sepsis Is accompanied by the occurrence of intravascular soluble fibrin , a decrease in coagulation inhibitors (antithrombin) and thrombocytopenia. The most sensitive and specific test for DIC seems to be the detection of fibrin monomers. Clinical symptoms of DIC are caused simultaneously by coms umption of coagulation factors (bleeding) and intravascular thrombosis (org an failure).