Therapy of septic coagulation disorders

Trauma, shock, and sepsis can lead to the activation of humoral and cellula r mechanisms which in health promote blood clot formation, inflammation, an d tissue repair, In patients With infections a substantial decrease of the antithrombin (AT) activity can be found which correlates with the severity of the underlying disease, In adults with septic shock an attenuation of DI C and decreased mortality call be achieved by AT administration, AT substit ution is at present one of the promising options in the therapy of patients ,vith SIRS in order to terminate DIC, prevent pulmonary microvascular obstr uction, and possibly increase survival, The additional use of heparin was t herapeutically not effective in shock patients with DIC. AT bound to glycos aminoglycans is able to liberate prostacyclin from human endothelial cells, Thus, intravenous heparin may compete with the physiological receptor of A T and inhibit prostacyclin release, Fresh frozen plasma and coagulation fac tor concentrates are indicated for balanced substitution of haemostasis in patients with bleeding and at clinically relevant risk of bleeding, In any case, procoagulant concentrate administration has to be preceded by inhibit or (AT) treatments for prevention of DIC or thromboembolism.