Hemostasis

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.