Sepsis and disseminated intravascular coagulation

Area of Science:

• Sepsis research
• Coagulation disorders
• Inflammation and immunity

Background:

• Sepsis often leads to coagulopathy, with disseminated intravascular coagulation (DIC) occurring in 35% of severe cases.
• Tissue factor (TF) from immune cells initiates coagulation in sepsis; Factor Xa (FXa) amplifies TF expression.
• High-mobility group box 1 (HMGB1) contributes to sepsis severity and coagulopathy, and thrombomodulin (TM) can bind and aid HMGB1 cleavage.

Purpose of the Study:

• To review the role of inflammation and coagulation in sepsis-induced DIC.
• To highlight the use of antithrombin (AT) and recombinant thrombomodulin (TM) in Japan for septic DIC.
• To suggest further international validation and cost-effectiveness studies for AT and TM in septic DIC.

Main Methods:

• Literature review of sepsis, DIC, coagulation, and inflammation.
• Analysis of the mechanisms involving TF, FXa, HMGB1, and TM in sepsis.
• Examination of treatment strategies employed in Japan, including AT and recombinant TM.

Main Results:

• Sepsis-related DIC involves complex interactions between inflammatory cytokines and the coagulation cascade.
• FXa plays a dual role in promoting TF expression and influencing immune responses.
• Recombinant TM and AT are aggressively used in Japan for septic DIC, with reported efficacy.

Conclusions:

• Inflammation and coagulation are critical components of sepsis-induced DIC.
• TF and HMGB1 are key mediators in the pathogenesis of septic DIC.
• Further global research on the efficacy and cost of recombinant TM and AT is warranted to support their broader clinical adoption.