Semin Thromb Hemost 2008; 34(8): 742-746
DOI: 10.1055/s-0029-1145256
© Thieme Medical Publishers

Sepsis, Coagulation, and Antithrombin: Old Lessons and New Insights

Marcel Levi1 , Marcel Schouten1 , 2 , 3 , Tom van der Poll1 , 2 , 3
  • 1Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  • 2Laboratory of Experimental Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  • 3Center for Infection and Inflammation Research (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Further Information

Publication History

Publication Date:
12 February 2009 (online)

ABSTRACT

Current insights in the pathogenesis of multiple organ dysfunction in patients with sepsis point to a pivotal role of inflammation and coagulation. One of the most important mechanisms contributing to the activation of coagulation in sepsis is the downregulation of physiologic anticoagulant systems, such as the antithrombin pathway. More than 20 years ago, Eberhard Mammen already hypothesized that coagulation activation and antithrombin were important factors in patients with sepsis. Abundant experimental and clinical studies have supported that notion in recent years. The better understanding of the pathogenesis of coagulation activation and the role of natural anticoagulants in sepsis has led to the development of anticoagulant factor concentrates, such as antithrombin concentrate. Clinical studies indicate that these interventions may have a role in the (supportive) treatment of patients with sepsis, mostly based on surrogate outcomes, but ongoing studies will have to confirm a beneficial effect in reducing mortality.

REFERENCES

Marcel Levi, M.D. , Ph.D. , F.R.C.P. 

Department of Medicine (F-4), Academic Medical Center, University of Amsterdam

Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

Email: m.m.levi@amc.uva.nl