Pregledni rad
https://doi.org/10.26800/LV-145-supl4-17
Evaluation of sepsis-induced coagulopathy in critically ill patients
Helena Ostović
orcid.org/0000-0002-4521-4366
; Klinika za anesteziologiju, reanimatologiju i intenzivnu medicinu, Klinička bolnica Dubrava, Zagreb
Brankica Šimac
orcid.org/0000-0002-6606-7879
Ana Smajo
orcid.org/0000-0001-6863-6070
Jasminka Peršec
orcid.org/0000-0002-3777-8153
Sažetak
Due to the interaction of the inflammatory response and the coagulation cascade, disorders of the coagulation system are a frequent complication of sepsis. Clinical manifestations include a wide range of hemostatic changes that vary from subtle forms of coagulopathies to fulminant disseminated intravascular coagulation (DIC). A specific characteristic of sepsis-induced coagulopathy (SIC) is excessive activation of coagulation processes with marked suppression of fibrinolysis. Three pathogenetic elements are essential in the development of DIC in sepsis: coagulation activation, platelet aggregation and vascular endothelial cell damage. Additionally, the activity of the anticoagulant system is reduced and the function of the fibrinolytic system is suppressed. There is still no gold standard for diagnosing SIC, so the diagnosis is based on conventional laboratory measurements, diagnostic criteria for SIC and DIC, and viscoelastic hemostatic assays. Laboratory measurements include classic coagulation tests available in most hospital laboratories: platelet count, prothrombin time and international standardizing
ratio, fibrin degradation products (FDPs) and fibrinogen. Thrombocytopenia, prolonged prothrombin time, elevated FDP levels, and decreased fibrinogen levels are common coagulation abnormalities accompanying sepsis. Diagnostic criteria have been released by the International Society on Thrombosis and Hemostasis (ISTH) and the Japanese Association for Acute Medicine (JAAM) that consists of a combination of coagulation test results. Viscoelastic hemostatic assays, such as rotational thromboelastometry (ROTEM) and thromboelastography (TEG), are used to complement the measurement of fibrinolytic system activity. Although there is no clearly defined management for septic coagulopathy, available treatment depends on the stage of the disease and includes anticoagulants (unfractionated and low-molecular-weight heparin, antithrombin, thrombomodulin) in the earlier course of the disease and replenishment of platelets and coagulation factors if complications related to bleeding have occurred. As it is a poor prognostic factor, early detection of SIC with appropriate therapy is the goal of the evaluation of critically ill patients with sepsis.
Ključne riječi
BLOOD COAGULATION; CRITICALLY ILL; DISSEMINATED INTRAVASCULAR COAGULATION; PLATELET COUNT; SEPSIS
Hrčak ID:
310280
URI
Datum izdavanja:
20.11.2023.
Posjeta: 299 *