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Septic Coagulopathy: Pathophysiology, Diagnosis, and Therapeutic Strategies

  • Sepsis in the ICU (J Lipman, Section Editor)
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Abstract

Purpose of Review

Septic coagulopathy is a complex disorder linked with multiple organ dysfunction and increased mortality, and definitive treatments are still lacking. This review summarizes the current understanding of septic coagulopathy, covering its pathophysiology, diagnosis, and debatable treatment approaches. Additionally, it provides a thorough overview of recent research and emerging trends in this area.

Recent Findings

Recent studies have highlighted the interplay between coagulation mechanisms in sepsis and inflammatory response. Diagnostic tools include the newly published scoring system for sepsis-induced coagulopathy and the existing scoring systems for disseminated intravascular coagulation, enhancing early detection and treatment. Several drugs targeting abnormal clotting have been investigated in septic coagulopathy or wider septic groups, including heparin, antithrombin, activated protein C, and human-soluble thrombomodulin. However, they have not yielded clear survival benefits. Nonetheless, recent studies indicate that some of those therapies may benefit specific groups with septic coagulopathy, emphasizing the growing interest in emerging biomarkers and precision medicine to enhance patient outcomes.

Summary

Despite recent advancements, no pharmaceutical intervention is currently endorsed for septic coagulopathy. However, a noted association exists between disseminated intravascular coagulation and unfavorable prognosis. Future research is imperative, especially in devising individualized treatment strategies tailored to each patient’s condition.

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  1. Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan

    Toshiyuki Karumai, Yuki Kotani, Ryohei Yamamoto, Mayuko Tonai & Yoshiro Hayashi

  2. School of Medicine, Vita-Salute San Raffaele University, Milan, Italy

    Yuki Kotani

  3. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Yuki Kotani

  4. Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University Hospital, Fukushima, Japan

    Ryohei Yamamoto

  5. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan

    Mayuko Tonai

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Karumai, T., Kotani, Y., Yamamoto, R. et al. Septic Coagulopathy: Pathophysiology, Diagnosis, and Therapeutic Strategies. Curr Infect Dis Rep 26, 91–106 (2024). https://doi.org/10.1007/s11908-024-00833-z

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