Sepsis-Induced Coagulopathy and Disseminated Intravascular Coagulopathy

Sponsoring Organizations: The Scientific and Standardization Committee on Disseminated Intravascular Coagulopathy and the Scientific and Standardization Committee on Perioperative and Critical Care of the International Society on Thrombosis and Haemostasis

Background and Objective

Hematologists are frequently called upon to interpret coagulation tests and manage coagulopathy in critically ill patients. Mainstays of managing disseminated intravascular coagulopathy (DIC) include treatment of the underlying cause and support with guided blood product transfusions. Anticoagulation is controversial, but subgroups of critically ill patients with coagulopathy may benefit from anticoagulation. As such, an international expert panel emphasizes the importance of early identification of coagulopathy, proposes “sepsis-induced coagulopathy” (SIC) as a preceding phase, and offers diagnostic and management strategies.

Key Points

• Suspect SIC with an International Society of Thrombosis and Haemostasis scoring system score ≥4, based on abnormalities of the platelet count: 1 point if 100–150×10⁹/L, 2 points if <100×10⁹/L; prothrombin time/international normalized ratio (PT/INR): 1 point if 1.2–1.4, 2 points if >1.4; and the sequential organ failure assessment (SOFA) scoring system, which assesses organ (respiratory, hepatic, cardiovascular, and renal) dysfunction: 1 point if 1, 2 points if ≥2
• If SIC is diagnosed, calculate an overt DIC score based on severity of thrombocytopenia, increase in d-dimer/fibrin degradation products, prolongation of the PT/INR, and decrease in fibrinogen.
• Consider low-molecular-weight heparin over unfractionated heparin in hope of preventing evolution of coagulopathy to overt DIC.
• Symmetrical peripheral gangrene is discussed as a consequence of DIC, but panelists acknowledge the uncertain efficacy of using anticoagulation for prevention.