Coagulation in sepsis

Published on October 31, 2016   39 min

A selection of talks on Clinical Practice

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Good day, this is Marcel Levi, from the Academic Medical Center of the University of Amsterdam in the Netherlands. And I'm going to present a talk on the coagulopathy associated with sepsis.
In systemic inflammatory states, as may be the case in patients with severe infection or even sepsis, there is always some degree of coagulation activation. This can be detected when you use sensitive assays for molecular markers of activated coagulation factors or pathways. But if it's sufficiently severe, you're also going to see laboratory abnormalities in routine coagulation tests like the platelet count or prolongation of the global clotting tests, APTT and PT, and in its most extreme form, disseminated intravascular coagulation may occur.
Actually what we see in the laboratory, especially in the routine laboratory, is probably the tip of the iceberg. Under the surface, there is a lot of coagulation activation that may be clinically relevant, present in patients with severe infection and sepsis and the associated systemic inflammatory states.
Disseminated intravascular coagulation is often seen as a confusing clinical entity. This is also reflected by the various names that can be found for the condition in textbooks. Are they surgical or intensive care textbooks or textbooks of hematology and internal medicine? But actually all these name points to the same clinical entity that we nowadays call disseminated intravascular coagulation.
DIC has been with us for centuries and it's probably the first description stems from many, many years ago. In the first experimental setting with what we would now call experimental DIC was described in 1834 in Paris, when injection of brain material into animals resulted in a widespread activation of coagulation, resulting in clot formation and also death of the animals.