Management of sepsis-induced disseminated intravascular coagulopathy using antithrombin and heparin, and the use of thromboelastometry in establishing the diagnosis of heparin resistance
Authors:
M. Durila 1; P. Salaj 2; H. Součková 3; M. Astraverkhava 1; J. Beroušek 1
Authors‘ workplace:
Klinika anesteziologie, resuscitace a intenzivní medicíny, 2. LF UK a FN Motol, Praha
1; Ústav hematologie a krevní tranfuze, Centrum pro trombózu a hemostázu, Praha
2; Gynekologicko-porodnická klinika, 2. LF UK a FN Motol, Praha
3
Published in:
Anest. intenziv. Med., 27, 2016, č. 6, s. 358-363
Category:
Intesive Care Medicine - Case Report
Overview
Severe sepsis is often accompanied by disseminated intravascular coagulation (DIC) and multiple organ dysfunction. Increased activation of coagulation is characteristic for this syndrome and therefore, from the pathophysiological point of view, it would be logical to intervene at the initiation of coagulation by the administration of antithrombin and heparin. Evidence from randomized studies offering clear instructions on the usage of these drugs is lacking though. In our case report we describe the management of septic DIC with antithrombin and heparin without bleeding complication. We have found that in order to stop the consumption of the coagulation blood components, it is required to maintain antithrombin levels above 90%. Because of the high risk of heparin resistance in sepsis it is appropriate to monitor the level of heparin with anti Xa with the aim of 0.5–0.6.
KEYWORDS:
antithrombin – heparin – heparin resistance – disseminated intravascular coagulation – thromboelastometry
Sources
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5. Durila, M., Teslík, L., Astraverkhava, M., Vymazal, T. Úloha tromboelastometrie a antitrombínu v manažmente počínajúcej diseminovanej intravaskulárnej koagulopatie po peripartálnej hysterektómii. Anest. Intenziv. Med., 2016, 27, 2, p. 75–77.
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Labels
Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
2016 Issue 6
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