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Title: Stollingsmodulatie bij sepsis
Author(s): MEERSSEMAN W
Journal: Tijdschrift voor Geneeskunde
Volume: 66    Issue: 5   Date: 2010   
Pages: 244-250
DOI: 10.2143/TVG.66.05.2000716

Abstract :
Sepsis gaat zeer vaak gepaard met systemische activatie van stollingsfactoren, wat kan leiden tot levensbedreigende orgaanschade in de meest ernstige gevallen. Er is een complexe interactie tussen inflammatie en stolling. Een diagnose van sepsisgeassocieerde diffuse intravasale stolling kan gemaakt worden aan de hand van enkele courant gebruikte stollingstesten, waarvoor heden ten dage simpele diagnostische algoritmen ter beschikking zijn. Strategie├źn om in te grijpen op stolling tijdens sepsis lijken van theoretisch oogpunt zinvol en verschillende studies zijn onderweg.





Coagulation in sepsis: pathophysiology and treatment
An important aspect of sepsis is the alteration of the procoagulant-anticoagulant balance, with an increase in procoagulant factors and a decrease in anticoagulant factors. This may lead to the formation of microvascular thrombi.
Anticoagulant factors (e.g., protein C, protein S, antithrombin III, and tissue factor-pathway inhibitor) modulate coagulation. Recombinant human activated protein C, an anticoagulant, is the first anticoagulant agent which has been proven to be effective in the treatment of sepsis. Activated protein C has direct anti-inflammatory properties. A puzzling issue remains the success of activated protein C whereas two other anticoagulants, antithrombin III and tissue factor-pathway inhibitor, failed as treatments of sepsis.
In this article, we review the pathophysiology of disturbed coagulation in sepsis as well as the available studies with agents intervening in coagulation secondary to sepsis.

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