Influence of antithrombin and argatroban on disseminated intravascular coagulation parameters in a patient with septic shock.

摘要

Sepsis is a leading cause of mortality in intensive care and is commonly associated with disseminated intravascular coagulation (DIC), characterized by massive systemic intravascular coagulation activation and inhibition of fibrinolysis [1], leading to widespread deposition of fibrin in the circulatory system with inadequate fibrin removal, micro vascular thrombosis and finally multiple organ dysfunction (MOD), which is associated with poor outcome. At the same time, excessive consumption of platelets and coagulation factors may induce severe bleeding [2]. Up to now, there is no consensus on the appropriate anticoagulant therapy of septic DIC. A number of controlled clinical trials with coagulation inhibitors have been published [3]. In DIC no beneficial effects of heparin could be seen. In one trial, activated protein C (APC) significantly improved the outcome of patients with septic DIC [4] but bleeding complications, especially in thrombocytopenia and costs [5] limit its use. Furthermore, there is ongoing debate regarding protocol and data analysis of the APC trial [6,7,8].