The coagulopathy in sepsis: significance and implications for treatment

  • Paola Saracco | paola.saracco@unito.it Hematology Unit, Department of Pediatrics, University of Turin, Italy.
  • Pasquale Vitale Pediatric Intensive Care Unit, Emergency Department, Regina Margherita S.Anna Hospital, Turin, Italy.
  • Carlo Scolfaro Infective Disease Unit, Department of Pediatrics, University of Turin, Italy.
  • Berardino Pollio Immunohematology and Transfusion Medicine Unit, Department of Laboratory diagnostic Services, Regina Margherita S.Anna Hospital, Turin, Italy.
  • Mauro Pagliarino Immunohematology and Transfusion Medicine Unit, Department of Laboratory diagnostic Services, Regina Margherita S.Anna Hospital, Turin, Italy.
  • Fabio Timeus Oncohematology and Stem Cell Transplant Unit, Department of Oncology, Regina Margherita S.Anna Hospital, Turin, Italy.

Abstract

Sepsis related coagulopathy ranges from mild laboratory alterations up to severe disseminated intravascular coagulation (DIC). There is evidence that DIC is involved in the pathogenesis of microvascular dysfunction contributing to organ failure. Additionally, the systemic activation of coagulation, by consuming platelets and coagulation factors, may cause bleeding. Thrombin generation via the tissue factor/factor VIIa route, contemporary depression of antithrombin and protein C anticoagulant system, as well as impaired fibrin degradation, due to high circulating levels of PAI-1, contribute to enhanced intravascular fibrin deposition. This deranged coagulopathy is an independent predictor of clinical outcome in patients with severe sepsis. Innovative supportive strategies aiming at the inhibition of coagulation activation comprise inhibition of tissue factor-mediated activation or restoration of physiological anticoagulant pathways, as the administration of recombinant human activated protein C or concentrate. In spite of some promising initial studies, additional trials are needed to define their clinical effectiveness in adults and children with severe sepsis.

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Published
2011-12-12
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Section
Reviews
Keywords:
Sepsis, disseminated activated coagulation, coagulopathy, treatment
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How to Cite
Saracco, P., Vitale, P., Scolfaro, C., Pollio, B., Pagliarino, M., & Timeus, F. (2011). The coagulopathy in sepsis: significance and implications for treatment. Pediatric Reports, 3(4), e30. https://doi.org/10.4081/pr.2011.e30