Newly Published
Clinical Focus Review  |   January 2020
Sepsis-induced Coagulopathy and Disseminated Intravascular Coagulation
Author Notes
  • From the Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan (T.I.); and the Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, North Carolina (J.H.L.).
  • Submitted for publication June 24, 2019. Accepted for publication December 6, 2019.
    Submitted for publication June 24, 2019. Accepted for publication December 6, 2019.×
  • Correspondence: Address correspondence to Dr. Iba: Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan. toshiiba@cf6.so-net.ne.jp. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Coagulation and Transfusion / Critical Care / Hematologic System / Infectious Disease / Clinical Focus Review
Clinical Focus Review   |   January 2020
Sepsis-induced Coagulopathy and Disseminated Intravascular Coagulation
Anesthesiology Newly Published on January 22, 2020. doi:https://doi.org/10.1097/ALN.0000000000003122
Anesthesiology Newly Published on January 22, 2020. doi:https://doi.org/10.1097/ALN.0000000000003122
Patients with sepsis commonly require invasive procedures and frequently have an associated coagulopathy.1  In a recent observational survey conducted in Japan, among 1,895 patients with sepsis treated in intensive care units, 29% were diagnosed with sepsis-induced coagulopathy, a term that is synonymous with disseminated intravascular coagulation (DIC) as defined by laboratory criteria.2  In patients with sepsis, the imbalance in clot generation (coagulation) and clot breakdown (fibrinolysis) is a pivotal response that occurs due to host defense mechanisms but is associated with the development of organ dysfunction.3,4  In a prior Anesthesiology editorial, Gropper suggested that “all of these conditions (in sepsis) likely share a common pathway for the development of multiple system organ failure: diffuse activation of endothelium by proinflammatory cytokines, leukocytes, and other proteins. Activated endothelium becomes prothrombotic in these conditions, leading to the formation of microvascular thrombosis. In addition, fibrinolysis is inhibited, resulting in the buildup of fibrin thrombus, which itself is proinflammatory.”5  This description is also consistent with our understanding of the coagulopathy that occurs in sepsis, which is more commonly described as DIC. Although sepsis is a common cause of DIC, other pathophysiologic states including trauma, cardiogenic shock, or acute ischemic injury can also cause DIC, a pathologic diagnosis and clinical sequelae due to another underlying disease process. Inflammatory responses after surgery, in particular after cardiopulmonary bypass, can produce a systemic inflammatory response syndrome and coagulopathy.