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Management of Dysregulated Immune Response in the Critically Ill pp 233–253Cite as

Hemostasis

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Part of the book series: Lessons from the ICU ((LEICU))

Abstract

Inflammation and coagulation are tightly connected, whereby an inflammatory host response will activate coagulation, resulting in a spectrum of coagulopathies that range from a mildly decreased platelet count to disseminated intravascular coagulation (DIC). Since also mild forms of coagulopathies are clinically relevant, this phenomenon is referred to as inflammation-induced coagulopathy. A variety of conditions causing critical illness are associated with inflammation-induced coagulopathy, the most important of which is sepsis. Inflammation-induced coagulopathy is characterized by a depletion of coagulation factors and platelets, as well as a decrease in anticoagulant proteins and inhibition of fibrinolysis. The result is that patients across the whole range of inflammation-induced coagulopathy have an increased risk of bleeding as well as thrombosis, rendering management complex. Treatment of the underlying cause remains key. Pharmacological thromboprophylaxis should be started. There are data suggesting possible benefit of anticoagulant interventions for DIC, although not robust enough to warrant any recommendations. Prophylactic platelet transfusion is recommended in case of a platelet count beneath 10 × 109/L, whereas administration of prophylactic plasma is not advised. Antifibrinolytics should generally be withheld but are advised early in case of severe bleeding due to trauma, childbirth, or cardiac surgery.

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Authors and Affiliations

  1. Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands

    Romein W. G. Dujardin, Derek J. B. Kleinveld & Nicole P. Juffermans

  2. Department of Intensive Care, OLVG Hospital, Amsterdam, The Netherlands

    Romein W. G. Dujardin & Nicole P. Juffermans

  3. Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands

    Derek J. B. Kleinveld

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  1. Romein W. G. Dujardin
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  2. Derek J. B. Kleinveld
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  3. Nicole P. Juffermans
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Correspondence to Romein W. G. Dujardin .

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Editors and Affiliations

  1. Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary

    Zsolt Molnar

  2. Department of Critical Care, King’s College London, Guy’s & St Thomas’ NHS Foundation Trust, London, UK

    Marlies Ostermann

  3. The Queen’s Medical Research Institute Edinburgh BioQuarter, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK

    Manu Shankar-Hari

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Dujardin, R.W.G., Kleinveld, D.J.B., Juffermans, N.P. (2023). Hemostasis. In: Molnar, Z., Ostermann, M., Shankar-Hari, M. (eds) Management of Dysregulated Immune Response in the Critically Ill. Lessons from the ICU. Springer, Cham. https://doi.org/10.1007/978-3-031-17572-5_14

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