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Decoding Sepsis-Induced Disseminated Intravascular Coagulation: A Comprehensive Review of Existing and Emerging
Ahsanullah Unar1, Lorenzo Bertolino1, Fabian Patauner1
1Department of Precision Medicine, University of Campania 'L. Vanvitelli', 80138 Naples, Italy.
Insights
Disseminated intravascular coagulation (DIC) is a serious sepsis complication. This review analyzes treatments like corticosteroids and immunomodulatory therapy, highlighting the need for randomized trials to improve patient outcomes.
Area of Science:
- Critical care medicine
- Hematology
- Infectious diseases
Background:
- Disseminated intravascular coagulation (DIC) frequently complicates sepsis, leading to organ dysfunction and poor prognosis.
- Understanding sepsis-induced DIC mechanisms is crucial for early diagnosis and effective management.
- Current treatment strategies face challenges despite ongoing research.
Purpose of the Study:
- To review and analyze current and emerging treatment strategies for sepsis-induced DIC.
- To evaluate the effectiveness and limitations of various therapeutic approaches.
- To explore potential treatments for DIC in the context of COVID-19.
Main Methods:
- Comprehensive literature review of sepsis-induced DIC treatments.
- Analysis of corticosteroids, recombinant thrombomodulin, vitamin C, and platelet transfusion.
- Examination of immunomodulatory therapies including G-CSF, GM-CSF, IFN-γ, and MSC therapy.
Main Results:
- Various treatments including corticosteroids, rTM, vitamin C, and platelet transfusions are discussed.
- Immunomodulatory therapies (IMT) such as G-CSF, GM-CSF, IFN-γ, and MSC therapy are explored.
- The review considers the impact of these therapies on COVID-19-associated DIC.
Conclusions:
- Targeted randomized trials are essential to validate treatment efficacy and discover novel therapies for sepsis-induced DIC.
- Enhanced understanding of sepsis-induced DIC pathophysiology can guide the development of life-saving interventions.
- Further research is needed to optimize treatment strategies and improve patient survival rates.
Abstract:
Disseminated intravascular coagulation (DIC) is a recurrent complication of sepsis. Since DIC not only promotes organ dysfunction but also represents a strong prognostic factor, it is important to diagnose DIC as early as possible. When coagulation is activated, fibrinolysis is inhibited, blood thinners are consumed, and a condition is created that promotes blood clotting, making it more difficult for the body to remove fibrin or prevent it from being deposited in the blood vessels. This leads to microvascular thrombosis, which plays a role in organ dysfunction. Despite efforts to understand the underlying mechanisms of sepsis-induced DIC, healthcare providers worldwide still face challenges in effectively treating this condition. In this review, we provide an in-depth analysis of the available strategies for sepsis-induced DIC, considering their effectiveness, limitations, and potential for future advances. Corticosteroids (CS), recombinant thrombomodulin (rTM), vitamin C, fibrinolytic therapy, and platelet transfusion are among the treatments discussed in the review. In addition, we are specifically addressing immunomodulatory therapy (IMT) by investigating treatments such as granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon gamma (IFN-γ), and mesenchymal stem cell therapy (MSC). Finally, we also examined how these therapies might affect COVID-19 cases, which often present with sepsis-induced DIC. The review suggests that targeted experiments with randomization are needed to verify the effectiveness of these treatments and to discover novel approaches to treat sepsis-induced DIC. By increasing our knowledge of sepsis-induced DIC, we can develop targeted treatments that have the potential to save lives and improve outcomes.
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