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The coagulopathy in sepsis: significance and implications for treatment

Sepsis related coagulopathy ranges from mild laboratory alterations up to severe disseminated intravascular coagulation (DIC). There is evidence that DIC is involved in the pathogenesis of microvascular dysfunction contributing to organ failure. Additionally, the systemic activation of coagulation,...

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Autores principales: Saracco, Paola, Vitale, Pasquale, Scolfaro, Carlo, Pollio, Berardino, Pagliarino, Mauro, Timeus, Fabio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: PAGEPress Publications 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3283198/
https://www.ncbi.nlm.nih.gov/pubmed/22355515
http://dx.doi.org/10.4081/pr.2011.e30
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author Saracco, Paola
Vitale, Pasquale
Scolfaro, Carlo
Pollio, Berardino
Pagliarino, Mauro
Timeus, Fabio
author_facet Saracco, Paola
Vitale, Pasquale
Scolfaro, Carlo
Pollio, Berardino
Pagliarino, Mauro
Timeus, Fabio
author_sort Saracco, Paola
collection PubMed
description Sepsis related coagulopathy ranges from mild laboratory alterations up to severe disseminated intravascular coagulation (DIC). There is evidence that DIC is involved in the pathogenesis of microvascular dysfunction contributing to organ failure. Additionally, the systemic activation of coagulation, by consuming platelets and coagulation factors, may cause bleeding. Thrombin generation via the tissue factor/factor VIIa route, contemporary depression of antithrombin and protein C anticoagulant systems, as well as impaired fibrin degradation, due to high circulating levels of PAI-1, contribute to enhanced intravascular fibrin deposition. This deranged coagulopathy is an independent predictor of clinical outcome in patients with severe sepsis. Innovative supportive strategies aiming at the inhibition of coagulation activation should comprise inhibition of tissue factor-mediated activation or restoration of physiological anticoagulant pathways, as the administration of recombinant human activated protein C or concentrate. In spite of some promising initial studies, additional trials are needed to define their clinical effectiveness in adults and children with severe sepsis.
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spelling pubmed-32831982012-02-21 The coagulopathy in sepsis: significance and implications for treatment Saracco, Paola Vitale, Pasquale Scolfaro, Carlo Pollio, Berardino Pagliarino, Mauro Timeus, Fabio Pediatr Rep Review Sepsis related coagulopathy ranges from mild laboratory alterations up to severe disseminated intravascular coagulation (DIC). There is evidence that DIC is involved in the pathogenesis of microvascular dysfunction contributing to organ failure. Additionally, the systemic activation of coagulation, by consuming platelets and coagulation factors, may cause bleeding. Thrombin generation via the tissue factor/factor VIIa route, contemporary depression of antithrombin and protein C anticoagulant systems, as well as impaired fibrin degradation, due to high circulating levels of PAI-1, contribute to enhanced intravascular fibrin deposition. This deranged coagulopathy is an independent predictor of clinical outcome in patients with severe sepsis. Innovative supportive strategies aiming at the inhibition of coagulation activation should comprise inhibition of tissue factor-mediated activation or restoration of physiological anticoagulant pathways, as the administration of recombinant human activated protein C or concentrate. In spite of some promising initial studies, additional trials are needed to define their clinical effectiveness in adults and children with severe sepsis. PAGEPress Publications 2011-12-12 /pmc/articles/PMC3283198/ /pubmed/22355515 http://dx.doi.org/10.4081/pr.2011.e30 Text en ©Copyright P. Saracco et al., 2011 This work is licensed under a Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Licensee PAGEPress, Italy
spellingShingle Review
Saracco, Paola
Vitale, Pasquale
Scolfaro, Carlo
Pollio, Berardino
Pagliarino, Mauro
Timeus, Fabio
The coagulopathy in sepsis: significance and implications for treatment
title The coagulopathy in sepsis: significance and implications for treatment
title_full The coagulopathy in sepsis: significance and implications for treatment
title_fullStr The coagulopathy in sepsis: significance and implications for treatment
title_full_unstemmed The coagulopathy in sepsis: significance and implications for treatment
title_short The coagulopathy in sepsis: significance and implications for treatment
title_sort coagulopathy in sepsis: significance and implications for treatment
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3283198/
https://www.ncbi.nlm.nih.gov/pubmed/22355515
http://dx.doi.org/10.4081/pr.2011.e30
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