SpringerLink
Log in

Coagulation Disorders in Intensive Care Patients

  • Chapter
  • First Online:
Perioperative Hemostasis

Abstract

Coagulation disorders are common in intensive care patients and may range from isolated thrombocytopenia or prolonged global clotting tests to complex defects, such as disseminated intravascular coagulation. There can be a wide variety of causes for coagulation derangements in critically ill patients, and each of the underlying disorders may require specific therapeutic management. Hence, an appropriate differential diagnosis and the initiation of adequate (supportive) treatment strategies are crucial to a reduction in morbidity and mortality in critically ill patients with coagulation abnormalities.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  • Ahmed A, Kojicic M, Herasevich V et al (2009) Early identification of patients with or at risk of acute lung injury. Neth J Med 67:268–271

    PubMed  CAS  Google Scholar 

  • Bailey B, Amre DK, Gaudreault P (2003) Fulminant hepatic failure secondary to acetaminophen poisoning: a systematic review and meta-analysis of prognostic criteria determining the need for liver transplantation. Crit Care Med 31:299–305

    Article  PubMed  CAS  Google Scholar 

  • Bernard GR, Vincent JL, Laterre PF et al (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699–709

    Article  PubMed  CAS  Google Scholar 

  • Dhainaut JF, Yan SB, Joyce DE et al (2004) Treatment effects of drotrecogin alfa (activated) in patients with severe sepsis with or without overt disseminated intravascular coagulation. J Thromb Haemost 2:1924–1933

    Article  PubMed  CAS  Google Scholar 

  • Eckle I, Seitz R, Egbring R et al (1991) Protein C degradation in vitro by neutrophil elastase. Biol Chem Hoppe Seyler 372:1007–1013

    Article  PubMed  CAS  Google Scholar 

  • Edmunds LH (2001) Hemostatic problems in surgical patients. In: Colman RW, Hirsh J, Marder VJ, Clowes AW, George JN (eds) Hemostasis and thrombosis. Basic principles and clinical practice. Lippincott William & Wilkins, Philadelphia, pp 1031–1043

    Google Scholar 

  • Esmon CT (1987) The regulation of natural anticoagulant pathways. Science 235:1348–1352

    Article  PubMed  CAS  Google Scholar 

  • Esmon CT (2000) The endothelial cell protein C receptor. Thromb Haemost 83:639–643

    PubMed  CAS  Google Scholar 

  • Esmon CT (2001) Role of coagulation inhibitors in inflammation. Thromb Haemost 86:51–56

    PubMed  CAS  Google Scholar 

  • Faust SN, Levin M, Harrison OB et al (2001) Dysfunction of endothelial protein C activation in severe meningococcal sepsis. N Engl J Med 345:408–416

    Article  PubMed  CAS  Google Scholar 

  • Folman CC, Linthorst GE, van Mourik J et al (2000) Platelets release thrombopoietin (Tpo) upon activation: another regulatory loop in thrombocytopoiesis? Thromb Haemost 83:923–930

    PubMed  CAS  Google Scholar 

  • Francois B, Trimoreau F, Vignon P et al (1997) Thrombocytopenia in the sepsis syndrome: role of hemophagocytosis and macrophage colony-stimulating factor. Am J Med 103:114–120

    Article  PubMed  CAS  Google Scholar 

  • Greaves M, Preston FE (2001) Approach to the bleeding patient. In: Colman RW, Hirsh J, Marder VJ, Clowes AW, George JN (eds) Hemostasis and thrombosis. Basic principles and clinical practice. Lip**cott William&Wilkins, Philadelphia, pp 1031–1043

    Google Scholar 

  • Griffin JH, Fernandez JA, Gale AJ et al (2007) Activated protein C. J Thromb Haemost 5(Suppl 1):73–80: 73–80

    Article  PubMed  CAS  Google Scholar 

  • Hellstern P, Muntean W, Schramm W et al (2002) Practical guidelines for the clinical use of plasma. Thromb Res 107(Suppl 1):S53

    Article  PubMed  CAS  Google Scholar 

  • Hermanides J, Huijgen R, Henny CP et al (2009) Hip surgery sequentially induces stress hyperglycaemia and activates coagulation. Neth J Med 67:226–229

    PubMed  CAS  Google Scholar 

  • Hirsh J, Heddle N, Kelton JG (2004) Treatment of heparin-induced thrombocytopenia: a critical review. Arch Intern Med 164:361–369

    Article  PubMed  CAS  Google Scholar 

  • Levi M (2012) Safety of prohemostatic interventions. Semin Thromb Hemost 38:282–288

    Article  Google Scholar 

  • Levi M, Lowenberg EC (2008) Thrombocytopenia in critically ill patients. Semin Thromb Hemost 34:417–424

    Article  PubMed  Google Scholar 

  • Levi M, Opal SM (2006) Coagulation abnormalities in critically ill patients. Crit Care 10:222

    Article  PubMed  PubMed Central  Google Scholar 

  • Levi M, ten Cate H (1999) Disseminated intravascular coagulation. N Engl J Med 341:586–592

    Article  PubMed  CAS  Google Scholar 

  • Levi M, van der Poll T (2008) The role of natural anticoagulants in the pathogenesis and management of systemic activation of coagulation and inflammation in critically ill patients. Semin Thromb Hemost 34:459–468

    Article  PubMed  CAS  Google Scholar 

  • Levi M, Cromheecke ME, de Jonge E et al (1999) Pharmacological strategies to decrease excessive blood loss in cardiac surgery: a meta-analysis of clinically relevant endpoints. Lancet 354:1940–1947

    Article  PubMed  CAS  Google Scholar 

  • Levi M, de Jonge E, van der Poll T (2001) Rationale for restoration of physiological anticoagulant pathways in patients with sepsis and disseminated intravascular coagulation. Crit Care Med 29:S90–S94

    Article  PubMed  CAS  Google Scholar 

  • Levi M, van der Poll T, Buller HR (2004) Bidirectional relation between inflammation and coagulation. Circulation 109:2698–2704

    Article  PubMed  Google Scholar 

  • Levi M, Nieuwdorp M, van der Poll T et al (2008) Metabolic modulation of inflammation-induced activation of coagulation. Semin Thromb Hemost 34:26–32

    Article  PubMed  CAS  Google Scholar 

  • Levi M, Toh CH, Thachil J et al (2009) Guidelines for the diagnosis and management of disseminated intravascular coagulation. Br J Haematol 145:24–33

    Article  PubMed  CAS  Google Scholar 

  • Levi M, Levy JH, Andersen HF et al (2010) Safety of recombinant activated factor VII in randomized clinical trials. N Engl J Med 363:1791–1800

    Article  PubMed  CAS  Google Scholar 

  • Levi M, Opal S (2010) Coagulation abnormalities in the critically ill. Surgical Intensive Care Medicine. O’Donnell J, Nacul F, Springer US: 371–378

    Google Scholar 

  • Levi M, Schouten M, van der Poll T (2008) Sepsis, coagulation, and antithrombin: old lessons and new insights. Semin Thromb Hemost 34:742–746

    Google Scholar 

  • Mannucci PM (1997) Desmopressin (DDAVP) in the treatment of bleeding disorders: the first 20 years. Blood 90:2515–2521

    PubMed  CAS  Google Scholar 

  • Mannucci PM, Levi M (2007) Prevention and treatment of major blood loss. N Engl J Med 356:2301–2311

    Article  PubMed  CAS  Google Scholar 

  • Mavrommatis AC, Theodoridis T, Orfanidou A et al (2000) Coagulation system and platelets are fully activated in uncomplicated sepsis. Crit Care Med 28:451–457

    Article  PubMed  CAS  Google Scholar 

  • Mesters RM, Helterbrand J, Utterback BG et al (2000) Prognostic value of protein C concentrations in neutropenic patients at high risk of severe septic complications. Crit Care Med 28:2209–2216

    Article  PubMed  CAS  Google Scholar 

  • Moake JL (2002) Thrombotic microangiopathies. N Engl J Med 347:589–600

    Article  PubMed  CAS  Google Scholar 

  • Nawroth PP, Stern DM (1986) Modulation of endothelial cell hemostatic properties by tumor necrosis factor. J Exp Med 163:740–745

    Article  PubMed  CAS  Google Scholar 

  • Porte RJ, Molenaar IQ, Begliomini B et al (2000) Aprotinin and transfusion requirements in orthotopic liver transplantation: a multicentre randomised double-blind study. EMSALT Study Group. Lancet 355:1303–1309

    Article  PubMed  CAS  Google Scholar 

  • Ranieri VM, Thompson BT, Barie PS et al (2012) Drotrecogin alfa (activated) in adults with septic shock. N Engl J Med 366:2055–2064

    Article  PubMed  CAS  Google Scholar 

  • Saito H, Maruyama I, Shimazaki S et al (2007) Efficacy and safety of recombinant human soluble thrombomodulin (ART-123) in disseminated intravascular coagulation: results of a phase III, randomized, double-blind clinical trial. J Thromb Haemost 5:31–41

    Article  PubMed  CAS  Google Scholar 

  • Schultz MJ (2009) Early recognition of critically ill patients. Neth J Med 67:266–267

    PubMed  CAS  Google Scholar 

  • Shakur H, Roberts I, Bautista R et al (2010) Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 376:23–32

    Article  PubMed  CAS  Google Scholar 

  • Shorr AF, Thomas SJ, Alkins SA et al (2002) D-dimer correlates with proinflammatory cytokine levels and outcomes in critically ill patients. Chest 121:1262–1268

    Article  PubMed  Google Scholar 

  • Stephan F, Hollande J, Richard O et al (1999) Thrombocytopenia in a surgical ICU. Chest 115:1363–1370

    Article  PubMed  CAS  Google Scholar 

  • Strauss R, Wehler M, Mehler K et al (2002) Thrombocytopenia in patients in the medical intensive care unit: bleeding prevalence, transfusion requirements, and outcome. Crit Care Med 30:1765–1771

    Article  PubMed  Google Scholar 

  • Taylor FBJ, Stearns-Kurosawa DJ, Kurosawa S et al (2000) The endothelial cell protein C receptor aids in host defense against Escherichia coli sepsis. Blood 95:1680–1686

    PubMed  CAS  Google Scholar 

  • Taylor FBJ, Toh CH, Hoots WK et al (2001) Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 86:1327–1330

    PubMed  CAS  Google Scholar 

  • Thachil J, Toh CH, Levi M et al (2012) The withdrawal of activated protein C from the use in patients with severe sepsis and DIC. Br J Haematol 37:10–2141

    Google Scholar 

  • Tsai HM (2003) Platelet activation and the formation of the platelet plug: deficiency of ADAMTS13 causes thrombotic thrombocytopenic purpura. Arterioscler Thromb Vasc Biol 23:388–396

    Article  PubMed  Google Scholar 

  • van den Born BJ, van der Hoeven NV, Groot E et al (2008) Association between thrombotic microangiopathy and reduced ADAMTS13 activity in malignant hypertension. Hypertension 51:862–866

    Article  PubMed  Google Scholar 

  • Vanderschueren S, De Weerdt A, Malbrain M et al (2000) Thrombocytopenia and prognosis in intensive care. Crit Care Med 28:1871–1876

    Article  PubMed  CAS  Google Scholar 

  • Vary TC, Kimball SR (1992) Regulation of hepatic protein synthesis in chronic inflammation and sepsis. Am J Physiol 262:C445–C452

    PubMed  CAS  Google Scholar 

  • Verma AK, Levine M, Shalansky SJ et al (2003) Frequency of heparin-induced thrombocytopenia in critical care patients. Pharmacotherapy 23:745–753

    Article  PubMed  Google Scholar 

  • Vlaar AP, Schultz MJ, Juffermans NP (2009) Transfusion-related acute lung injury: a change of perspective. Neth J Med 67:320–326

    PubMed  CAS  Google Scholar 

  • Warkentin TE (2003) Heparin-induced thrombocytopenia: pathogenesis and management. Br J Haematol 121:535–555

    Article  PubMed  CAS  Google Scholar 

  • Warkentin TE, Aird WC, Rand JH (2003) Platelet-endothelial interactions: sepsis, HIT, and antiphospholipid syndrome. Hematology Am Soc Hematol Educ Program 70:497–519

    Google Scholar 

  • Wheeler AP, Bernard GR (1999) Treating patients with severe sepsis. N Engl J Med 340:207–214

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Vascular Medicine and Internal Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands

    Marcel Levi MD

Authors
  1. Marcel Levi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcel Levi MD .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, University Hospital of Lausanne, Lausanne, Switzerland

    Carlo Enrique Marcucci

  2. Department of Anesthesiology, University Hospital of Lausanne, Lausanne, Switzerland

    Patrick Schoettker

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Levi, M. (2015). Coagulation Disorders in Intensive Care Patients. In: Marcucci, C., Schoettker, P. (eds) Perioperative Hemostasis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-55004-1_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-55004-1_22

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-55003-4

  • Online ISBN: 978-3-642-55004-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation