How we manage haemostasis during sepsis

Summary Sepsis may be associated with activation of the coagulation system and, in its most severe form, may result in disseminated intravascular coagulation (DIC). Initially, there is thrombosis primarily affecting small and medium sized vessels and contributing to organ dysfunction, but continued...

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Published in:British journal of haematology Vol. 185; no. 2; pp. 209 - 218
Main Authors: Scully, Marie, Levi, Marcel
Format: Journal Article
Language:English
Published: England Blackwell Publishing Ltd 01.04.2019
Subjects:
Anticoagulants - therapeutic use
Bleeding
bleeding disorders
Disseminated intravascular coagulation
Disseminated Intravascular Coagulation - diagnosis
Disseminated Intravascular Coagulation - etiology
Disseminated Intravascular Coagulation - therapy
Fibrin
Hematology
Hemostasis - physiology
Humans
Phenotypes
Sepsis
Sepsis - blood
Sepsis - complications
Sepsis - physiopathology
Severity of Illness Index
Thrombocytopenia
Thrombocytopenia - etiology
Thrombosis
bleeding disorders
sepsis
thrombosis
ISSN:0007-1048, 1365-2141, 1365-2141
Online Access:Get full text
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Summary:Summary Sepsis may be associated with activation of the coagulation system and, in its most severe form, may result in disseminated intravascular coagulation (DIC). Initially, there is thrombosis primarily affecting small and medium sized vessels and contributing to organ dysfunction, but continued activation results in consumption of coagulation factors. This results in prolongation of global coagulation parameters. Often thrombocytopenia is the initial feature in sepsis, which may be followed by prolongation of global coagulation assays, and in severe cases, associated with hypofibrinogenaemia, with overactivation of the fibrinolytic path. The end result is a bleeding phenotype. Scoring systems can be used to help identify patients at risk of DIC and aid in confirming a diagnosis of DIC utilising routine laboratory parameters. Discussion includes medical and blood product support of haemostasis, from thrombotic to bleeding states, in relation to sepsis trigger.
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ISSN:0007-1048
1365-2141
1365-2141
DOI:10.1111/bjh.15821