Coagulation disorders in critcally ill patients

Coagulation disorders in critcally ill patients Coagulation as a whole (comprising both coagulation and fibrinolysis) is a continuously balanced process. This process is an innate immune response limiting both the progression of damage and dissemination of pathogens and allowing both repair and pathogen clearance. Coagulation disorders in critically ill patients can be considered as organ failures in themselves and are due to deficits and/or dysfunctions of crucial elements of this response : endothelium, platelets, fibrinogen, thrombin, coagulation factors and cofactors (and inhibitors) and fibrinolytic enzymes and cofactors (and inhibitors). Aside from hemorrhage, the critically ill patient accumulates risk factors for hemorrhage such as thrombocytopenia, invasive procedures, medications interfering with coagulation therapeutically or through direct or immune-mediated toxicity, vitamin-deficiencies, hepatic failure, inflammation and sepsis. Sepsis-related coagulopathy is a specific, inappropriate, unbalanced, excessive and extensive innate coagulation response most often leading to thrombosis and microcirculatory dysfunction involved in organ failure. However sepsis-related coagulopathy also puts critically ill patients at risk for hemorrhage in case of invasive procedures, surgery or injury. Thus, coagulopathy in critically ill patients requires careful analysis and a comprehensive management strategy.