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

Citation
M. Levi et al., Rationale for restoration of physiological anticoagulant pathways in patients with sepsis and disseminated intravascular coagulation, CRIT CARE M, 29(7), 2001, pp. S90-S94
Citations number
49
Categorie Soggetti
Aneshtesia & Intensive Care
Journal title
CRITICAL CARE MEDICINE
ISSN journal
00903493 → ACNP
Volume
29
Issue
7
Year of publication
2001
Supplement
S
Pages
S90 - S94
Database
ISI
SICI code
0090-3493(200107)29:7<S90:RFROPA>2.0.ZU;2-H
Abstract
Objective: In the pathogenesis of disseminated intravascular coagulation, d ysfunctional natural anticoagulant pathways appear to play a pivotal role. In this article, we will address the mechanisms that contribute to this def ect in the regulation of coagulation activation. Furthermore, we will explo re the experimental and clinical evidence that restoration of these anticoa gulant pathways results in clinical improvement. Data Sources:We have searched and reviewed published articles on experiment al 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 antith rombin 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 pr inciple, by administration of coagulation inhibitor concentrates or recombi nant 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 paint of impa ct in patients with sepsis and an activated coagulation system, but also is associated with an improved outcome in experimental and (initial) clinical studies.