Sepsis-induced Coagulopathy and Disseminated Intravascular Coagulation

Patients with sepsis commonly require invasive procedures and frequently have an associated coagulopathy.1 In a recent observational survey conducted in Japan, among 1,895 patients with sepsis treated in intensive care units, 29% were diagnosed with sepsis-induced coagulopathy, a term that is synonymous with disseminated intravascular coagulation (DIC) as defined by laboratory criteria.2 In patients with sepsis, the imbalance in clot generation (coagulation) and clot breakdown (fibrinolysis) is a pivotal response that occurs due to host defense mechanisms but is associated with the development of organ dysfunction.3,4 In a prior Anesthesiology editorial, Gropper suggested that “all of these conditions (in sepsis) likely share a common pathway for the development of multiple system organ failure: diffuse activation of endothelium by proinflammatory cytokines, leukocytes, and other proteins. Activated endothelium becomes prothrombotic in these conditions, leading to the f ormation of microvascular thrombosis. In addition, fibrinolysis is inhibited, resulting in the buildup of fibrin thrombus, which itself is proinflammatory.”5 This description is also consistent with our understanding of the coagulopathy that occurs in sepsis, which is more commonly described as DIC. Although sepsis is a common cause of DIC, other pathophysiologic states including trauma, cardiogenic shock, or acute ischemic injury can also cause DIC, a pathologic diagnosis and clinical sequelae due to anot...
Source: Anesthesiology - Category: Anesthesiology Source Type: research