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Roles of Coagulation Abnormalities and Microthrombosis in Sepsis: Pathophysiology, Diagnosis, and Treatment
Toshiaki Iba1, Yutaka Umemura2, Hideo Wada3
1Department of Emergency and Disaster Medicine, Juntendo University Graduate, School of Medicine, Tokyo, Japan.
Insights
Sepsis-induced coagulopathy (SIC) criteria aid early detection of sepsis-associated disseminated intravascular coagulation (DIC). A two-step approach using SIC and overt DIC criteria helps manage this severe condition.
Area of Science:
- Critical care medicine
- Hematology
- Infectious diseases
Background:
- Disseminated intravascular coagulation (DIC) is linked to poor outcomes.
- Sepsis and septic shock involve inflammation and coagulation driving organ dysfunction.
- Newer understanding highlights coagulation disorders in sepsis progression.
Purpose of the Study:
- To introduce sepsis-induced coagulopathy (SIC) criteria for early detection of sepsis-associated DIC.
- To propose a two-step diagnostic approach combining SIC and overt DIC criteria.
- To discuss current management strategies and the need for future research.
Main Methods:
- Review of diagnostic criteria for overt DIC (ISTH, 2001) and SIC (ISTH, 2017).
- Explanation of SIC as a scoring system (platelet count, prothrombin time, organ dysfunction).
- Discussion of a two-step diagnostic strategy for sepsis-associated DIC.
Main Results:
- SIC criteria enable early detection of sepsis-associated DIC.
- The two-step approach (SIC + overt DIC) offers a novel strategy for severity evaluation and management.
- No universal anticoagulant therapy for DIC exists; Japanese guidelines recommend antithrombin and recombinant thrombomodulin.
Conclusions:
- A two-step approach using SIC and overt DIC criteria is a novel strategy for managing sepsis-associated DIC.
- International collaboration is essential for developing future diagnostic tools and treatments.
- Early detection and management of coagulation disorders in sepsis are crucial.
Abstract:
The diagnostic criteria of overt disseminated intravascular coagulation (DIC) were established by the International Society on Thrombosis and Haemostasis (ISTH) in 2001. Since then, DIC has long been associated with adverse outcomes. However, recent advances in sepsis shed light on the role of coagulation disorders in the progression of sepsis. Currently, inflammation and coagulation are recognized as the two drivers that promote organ dysfunction in sepsis and septic shock. The ISTH has published new diagnostic criteria for improved management, namely sepsis-induced coagulopathy (SIC), in 2017. SIC is a pragmatic scoring system composed of platelet count, prothrombin time, and organ dysfunction score to detect the early-stage of sepsis-associated DIC. Since overt DIC represents an uncompensated coagulation disorder, a two-step approach using SIC and overt DIC criteria is a novel strategy to evaluate the severity and manage this challenging complication. Although there is no globally agreed on anticoagulant therapy for DIC, the Japanese Surviving Sepsis Campaign Guidelines 2020 recommend using antithrombin and recombinant thrombomodulin for sepsis associated DIC. Since research in this area has been previously reported, an international collaborative study is necessary to develop future diagnostic tools and treatment strategies.
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