Sepsis-induced coagulopathy and disseminated intravascular coagulation

Abstract

The definition of sepsis is usually associated to the innate immune system while instead, it is also connected to a response of the coagulation system, given that in septic patients thrombohemorrhagic events occur. The activation of the immune response and the recruitment of the coagulation system aim at the compartmentalization in the vascular stream of the response to the microorganism to avoid its spreading. This mechanism, as a side effect, exposes the organism to a variety of “dysregulations”. Disseminated Intravascular Coagulation (DIC) can present itself in septic patients with one of three different phenotypes: pro-coagulant, fibrinolytic and hemorrhagic. Associated to DIC, as it can be considered its predecessor, is Sepsis-Induced Coagulopathy (SIC) a prior, faster-evolving condition. International institutions have developed a scoring system to distinguish SIC from overt-DIC, which has the distinctive characteristics of a reduced platelet count in the initial stages and a higher INR value. Being a rapidly evolving condition SIC needs to be quickly diagnosed and treated; to this day no concrete recommendations exist regarding a therapeutic approach. Unfractionated heparin, antithrombin III, thrombomodulin and recombinant protein C have shown limited, or even non-existing, effects in SIC treatment, while the use of thromboelastography and thromboelastometry has represented a progress in the testing of coagulation-hemorrhagic conditions. The procedure to be followed is, besides microcirculation resuscitation, a prompt intervention with antibiotic treatment and the execution of a de-escalation protocol. Further studies are still necessary to define the most effective treatment for these conditions.