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Anticoagulant Therapy in Sepsis The Importance of Timing
#MMPMID29967873
Scarlatescu E
; Tomescu D
; Arama SS
J Crit Care Med (Targu Mures)
2017[Apr]; 3
(2
): 63-69
PMID29967873
show ga
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.
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