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Disseminated intravascular coagulation in the ICU: pathophysiology, epidemiology, diagnostic and treatment Volume 13, issue 6, Novembre-Décembre 2007

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Authors
Service de réanimation médicale, Hôpital européen Georges-Pompidou, Paris, Service d’hématologie biologique, Hôpital européen Georges-Pompidou, Paris, INSERM U 765, Paris, Université René Descartes, Paris V, Paris, Université Paris-Sud, Paris XI, Laboratoire d’hématologie, Orsay

Disseminated intravascular coagulation (DIC) is a frequent complication of critical illnesses such as sepsis and polytrauma. DIC, as the failure of the coagulation system, often occurs together with failure of numerous other organs and participates in the multiorgan failure syndrome. DIC occurring during sepsis or trauma is associated with higher mortality. DIC is triggered by the exposition of tissue factor to blood, which is responsible for thrombin generation. Several amplification mechanisms lead to sustained and diffuse thrombin generation together with insufficient thrombolysis, reduction in endogenous anticoagulant (protein C, protein S, antithrombin) and platelet activation. These events result in diffuse microvascular thrombi formation, coagulation factors depletion and thrombopenia. Clinical consequences of DIC include hemorrhage and multiple organ failure in relation to tissue ischemia and to direct cellular effects notably through inflammation activation. A biological score based on standard blood tests (platelets count, fibrin degradation product, prothrombin time, fibrinogen concentration) has been recently proposed for the diagnosis of DIC by the International Society for Thrombosis and Hemostasis and has gained wide acceptance. However, except for the treatment of the initiating factor(s), there is currently no specific treatment for DIC. Replacement of coagulation factors and platelets are recommended in case of hemorrhage or risk of it. Several treatments recently proposed to treat septic patients, such as recombinant activated protein C, impact on coagulation but none had been shown beneficial specifically in the presence of DIC.