[Coagulofibrinolytic response to surgical insult]

During recent years, evidence has accumulated demonstrating bidirectional cross-talk in the classic neuroendocrine response as well as immune-mediated inflammatory response, and newly described coagulofibrinolytic response. This review outlines the influences that these systems exert on each other and discusses the implications of the coagulofibrinolytic response to the multiple-organ dysfunction syndrome (MODS) and patient prognosis. The results of the physiological coagulofibrinolytic response to physical insults such as surgery and trauma are hemostasis and wound healing. We stress that this response is nonspecific and is similar in all types of insult without exception. An abnormal hemostatic response to surgical insult is called disseminated intravascular coagulation (DIC). DIC associated with the sustained systemic inflammatory response syndrome (SIRS) in postsurgical insult leads to the development of MODS, which is the main determinant of patient outcome. To prevent the progression of DIC, new drugs like activated protein C which can control both coagulation and inflammation now appear promising.