Immunohaemostasis: a new view on haemostasis during sepsis

Area of Science:

• * Infectious disease and immunology
• * Hematology and coagulation science

Background:

• * Host infection triggers systemic inflammation, innate immunity, complement, and hemostasis.
• * Thrombin's role has shifted from a cause of organ failure to a survival partner in septic shock.
• * Emerging roles of contact activation, polyphosphates, and neutrophil extracellular traps in host defense.

Purpose of the Study:

• * To review the pathophysiology of infection-induced hemostasis.
• * To discuss the diagnostic challenges and stratification of sepsis-induced coagulopathy.
• * To explore therapeutic strategies for managing hemostasis in sepsis.

Main Methods:

• * Review of current literature on hemostasis and infection.
• * Discussion of pathophysiology, diagnostic tools, and therapeutic interventions.
• * Analysis of clinical trial outcomes and future therapeutic directions.

Main Results:

• * Host defense peptides (HDPs) derived from coagulation factors exhibit potent antimicrobial activity.
• * Sepsis-induced coagulopathy ranges from adaptive hemostasis to disseminated intravascular coagulation (DIC).
• * International trials of anticoagulants in septic shock have yielded mixed results, questioning hemostasis as a sole therapeutic target.

Conclusions:

• * Understanding immunothrombosis is crucial for tailoring sepsis treatments.
• * Patients at high risk may benefit from therapies targeting excess thrombin generation.
• * Improved assessment of coagulation response, including DIC scores, is needed for personalized treatment allocation.