Coagulopathy commonly occurs in
sepsis as a critical host response to
infection that can progress to
disseminated intravascular coagulation (
DIC) with an increased mortality. Recent studies have further defined factors responsible for the thromboinflammatory response and intravascular
thrombosis, including neutrophil extracellular traps, extracellular vesicles, damage-associated molecular patterns, and endothelial glycocalyx shedding. Diagnosing
DIC facilitates
sepsis management, and is associated with improved outcomes. Although the International Society on
Thrombosis and Haemostasis (ISTH) has proposed criteria for diagnosing overt
DIC, these criteria are not suitable for early detection. Accordingly, the ISTH
DIC Scientific Standardization Committee has proposed a new category termed "
sepsis-induced coagulopathy (SIC)" to facilitate earlier diagnosis of
DIC and potentially more rapid interventions in these
critically ill patients.
Therapy of SIC includes both treatment of the underlying
infection and correcting the coagulopathy, with most therapeutic approaches focusing on
anticoagulant therapy. Recently, a phase III trial of recombinant
thrombomodulin was performed in coagulopathic patients. Although the 28-day mortality was improved by 2.6% (absolute difference), it did not reach statistical significance. However, in patients who met entry criteria for SIC at baseline, the mortality difference was approximately 5% without increased risk of
bleeding. In this review, we discuss current advances in managing SIC and
DIC.