Link between coagulation abnormalities and microcirculatory dysfunction in critically ill patients
Daniel De Backer1, Katia Donadello, Raphaël Favory
1Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. ddebacke@ulb.ac.be
Purpose Of Review:
The current review discusses the role of coagulation in microcirculatory abnormalities and whether anticoagulants may improve microvascular perfusion.
Recent Findings:
Microvascular alterations frequently occur in sepsis and ischemia-reperfusion injury. These alterations are due to endothelial dysfunction and interaction of endothelium and circulating cells. Although the activation of coagulation has been extensively shown to occur in these conditions, microthrombosis seems not to be a predominant factor. Nevertheless, the interplay between coagulation, inflammation and the endothelium seems to favor microvascular dysfunction. Several agents with anticoagulant properties, especially activated protein C and antithrombin, improve the diseased microcirculation, but these agents have pleiotropic effects, and it seems unlikely that these beneficial effects are linked to direct inhibition of coagulation. Current evidence does not support the use of pure anticoagulant agents to improve microvascular perfusion.
Summary:
The activation of coagulation may play an indirect role in microvascular dysfunction, through interplay with endothelium and inflammation.
Related Concept Videos
Disorders of Hemostasis
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
Extrinsic and Intrinsic Pathways of Hemostasis
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which forms a...
Coagulation
During the coagulation phase, clotting factors, or procoagulants, play a vital role in initiating and progressing the coagulation cascade. This cascade is a series of reactions...
Anticoagulant Drugs: Low-Molecular-Weight Heparins
Acute Inflammation III: Local and Systemic Effects
Introduction to Hemostasis
The three phases of hemostasis involve many clotting factors present in plasma and several substances released by platelets and injured tissue cells. It is a fast, localized, and...

