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Coagulation dysfunction in sepsis and multiple organ system failure.

Marianne Nimah1, Richard J Brilli

  • 1Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.

Critical Care Clinics
|July 10, 2003
PubMed
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Severe sepsis and septic shock involve coagulation dysfunction. Activated protein C (aPC) shows promise in reducing mortality in adults, while antithrombin III (AT III) replacement therapy has limited efficacy.

Area of Science:

  • Coagulation and Thrombosis
  • Critical Care Medicine
  • Sepsis Pathophysiology

Background:

  • Sepsis triggers endothelial injury and TF activation, leading to procoagulant and antifibrinolytic states.
  • This dysregulation can cause microvascular thrombosis, ischemia, and organ dysfunction.
  • Current treatments for sepsis-induced coagulation disorders have variable success rates.

Purpose of the Study:

  • To review the role of coagulation dysfunction in sepsis.
  • To evaluate the efficacy of replacement therapies like antithrombin III and activated protein C (aPC).

Main Methods:

  • Review of current data on coagulation dysfunction in sepsis.
  • Analysis of clinical trial outcomes for AT III and aPC replacement therapies in adult sepsis patients.

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Main Results:

  • Antithrombin III (AT III) replacement therapy demonstrated limited efficacy in adult severe sepsis.
  • Activated protein C (aPC) treatment significantly reduced mortality in adult severe sepsis with organ failure compared to placebo.
  • A pediatric trial for protein C therapy in severe sepsis is ongoing.

Conclusions:

  • Coagulation dysfunction is a critical component of severe sepsis and septic shock.
  • Activated protein C (aPC) represents a potential therapeutic strategy for severe sepsis with organ failure in adults.
  • Further research, including pediatric trials, is warranted to optimize treatment for sepsis-induced coagulopathy.