Sepsis-Induced Coagulopathy: An Update on Pathophysiology, Biomarkers, and Current Guidelines

Abstract

Significant cross talk occurs between inflammation and coagulation. Thus, coagulopathy is common in sepsis, potentially aggravating the prognosis. Initially, septic patients tend to exhibit a prothrombotic state through extrinsic pathway activation, cytokine-induced coagulation amplification, anticoagulant pathways suppression, and fibrinolysis impairment. In late sepsis stages, with the establishment of disseminated intravascular coagulation (DIC), hypocoagulability ensues. Traditional laboratory findings of sepsis, including thrombocytopenia, increased prothrombin time (PT) and fibrin degradation products (FDPs), and decreased fibrinogen, only present late in the course of sepsis. A recently introduced definition of sepsis-induced coagulopathy (SIC) aims to identify patients at an earlier stage when changes to coagulation status are still reversible. Nonconventional assays, such as the measurement of anticoagulant proteins and nuclear material levels, and viscoelastic studies, have shown promising sensitivity and specificity in detecting patients at risk for DIC, allowing for timely therapeutic interventions. This review outlines current insights into the pathophysiological mechanisms and diagnostic options of SIC.

Thromboelastometry and prediction of in‐hospital mortality in neonates with sepsis

“…The overlap of these two systems is attributed to a common pathway; the interaction of the vascular endothelium with platelets and neutrophils. 17 Hemostatic derangements are common and sometimes life-threatening through sepsis progress in neonates. Recent studies showed that ROTEM is able to detect sepsis-evoked alterations of hemostasis and could be used as an early indicator of neonatal sepsis.…”

A Pilot Observational Study Evaluating the Diagnostic Capacity of Rotational Thromboelastometry in Periprosthetic Joint Infections

“…I nfection is associated with a prothrombotic state due to several pathogenetic mechanisms including extrinsic pathway activation, cytokine-induced coagulation amplification, and fibrinolysis inhibition 7,[16][17][18][19] . The aim of this pilot study was to evaluate the association between hemostatic derangements, as reflected by ROTEM parameters, and the development of PJI.…”

“…Supporting material provided by the authors is posted with the online version of this article as a data supplement at jbjs.org (http://links.lww.com/JBJS/H739). n Andreas G. Tsantes, MD 1,2 Dimitrios V. Papadopoulos, MD 3 Stavros Goumenos, MD 4 Ioannis G. Trikoupis, MD 4 Konstantina A. Tsante 5 Vanesa Bellou, MD 6,7 Panagiotis Koulouvaris, MD 4 Dimitra Houhoula 1 Anastasios Kriebardis 5 Daniele Piovani 8,9 Georgios K. Nikolopoulos 10 Andreas F. Mavrogenis, MD 4 Panayiotis J. Papagelopoulos, MD 4 Stefanos Bonovas, MD 8,9 Argirios E. Tsantes, MD 1…”

“…Although several scores such as the 2018 International Consensus Meeting (ICM) criteria have been developed for PJI diagnosis, the best diagnostic approach is still being searched for [3][4][5] . There is a substantial body of literature linking infection with altered hemostatic dynamics; however, studies with regard to the relationship between hemostatic derangements and PJI have been sparse [6][7][8][9][10] .Viscoelastic studies such as rotational thromboelastometry (ROTEM) are whole-blood laboratory studies that evaluate all…”

Association Between Plasma Transfusion and in-Hospital Mortality in Critically Ill Patients With Sepsis-Induced Coagulopathy

“…Currently, there is no definitive treatment for SIC. However, considering that the main manifestations of SIC are enhanced coagulation function, anticoagulant inhibition, and microthrombosis, some studies recommended the use of anticoagulant drugs in these patients, although it remains controversial (19)(20)(21)(22).…”