<abstract xmlns="http://www.w3.org/1999/xhtml"><p> Sepsis associated coagulopathy is due to the inflammation-induced activation of coagulation pathways concomitant with dysfunction of anticoagulant and fibrinolytic systems, leading to different degrees of haemostasis dysregulation. This response is initially beneficial, contributing to antimicrobial defence, but when control is lost coagulation activation leads to widespread microvascular thrombosis and subsequent organ failure. Large clinical trials of sepsis-related anticoagulant therapies failed to show survival benefits, but posthoc analysis of databases and several smaller studies showed beneficial effects of anticoagulants in subgroups of patients with early sepsis-induced disseminated intravascular coagulation. A reasonable explanation could be the difference in timing of anticoagulant therapy and patient heterogeneity associated with large trials. Proper selection of patients and adequate timing are required for treatment to be successful. The time when coagulation activation changes from advantageous to detrimental represents the right moment for the administration of coagulation-targeted therapy. In this way, the defence function of the haemostatic system is preserved, and the harmful effects of overwhelming coagulation activation are avoided.</p></abstract>

Sepsis associated coagulopathy is due to the inflammation-induced activation of coagulation pathways concomitant with dysfunction of anticoagulant and fibrinolytic systems, leading to different degrees of haemostasis dysregulation. This response is initially beneficial, contributing to antimicrobial defence, but when control is lost coagulation activation leads to widespread microvascular thrombosis and subsequent organ failure. Large clinical trials of sepsis-related anticoagulant therapies failed to show survival benefits, but posthoc analysis of databases and several smaller studies showed beneficial effects of anticoagulants in subgroups of patients with early sepsis-induced disseminated intravascular coagulation. A reasonable explanation could be the difference in timing of anticoagulant therapy and patient heterogeneity associated with large trials. Proper selection of patients and adequate timing are required for treatment to be successful. The time when coagulation activation changes from advantageous to detrimental represents the right moment for the administration of coagulation-targeted therapy. In this way, the defence function of the haemostatic system is preserved, and the harmful effects of overwhelming coagulation activation are avoided.

Review. Anticoagulant Therapy in Sepsis. The Importance of Timing

The Journal of Critical Care Medicine

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

{"article-title":"Review. Anticoagulant Therapy in Sepsis. The Importance of Timing"}

Sepsis associated coagulopathy is due to the inflammation-induced activation of coagulation pathways concomitant with dysfunction of anticoagulant and...

Review. Anticoagulant Therapy in Sepsis. The Importance of Timing

Online veröffentlicht: 11. Mai 2017

Seitenbereich: 63 - 69

Eingereicht: 18. Jan. 2017

Akzeptiert: 24. März 2017

DOI: https://doi.org/10.1515/jccm-2017-0011

Schlüsselwörter
sepsis, Disseminated Intravascular Coagulation (DIC), anticoagulants

© 2017

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Review. Anticoagulant Therapy in Sepsis. The Importance of Timing

Online veröffentlicht: 11. Mai 2017

Seitenbereich: 63 - 69

Eingereicht: 18. Jan. 2017

Akzeptiert: 24. März 2017

DOI: https://doi.org/10.1515/jccm-2017-0011

Schlüsselwörtersepsis, Disseminated Intravascular Coagulation (DIC), anticoagulants

© 2017

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Schlüsselwörter
sepsis, Disseminated Intravascular Coagulation (DIC), anticoagulants