Skip to main content
SpringerLink
Log in

Changes of the Hemostatic Network in the Critically III

  • Conference paper
Yearbook of Intensive Care and Emergency Medicine 2001

Part of the book series: Yearbook of Intensive Care and Emergency Medicine 2001 ((YEARBOOK,volume 2001))

  • 207 Accesses

Abstract

Intensive care unit (ICU) patients suffering from severe illness (e.g., after major surgery, sepsis or trauma) are known to show a wide spectrum of coagulation abnormalities (Fig. 1) [1–3]. Thrombin generation and activation of fibrinolysis are physiologic responses to tissue damage during surgery and trauma [4]. This may result in an imbalance between the procoagulant and inhibitory processes of the coagulation system [1, 5]. In addition to the conventional components of the hemostatic system, other processes are involved in the development of hemostatic disorders in the ICU patient, e.g., activation of the inflammatory cascade may produce either activation or inhibition of the hemostatic process. Coagulation abnormalities in the critically ill are additionally triggered and/or modified by circulatory, respiratory or metabolic disorders [1]. Finally, extensive neuroendocrine response may enhance hemostatic alterations, including decreased fibrinolysis and increased platelet activity [6].

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Scherer R, Kox WJ (1993) Consumptive coagulopathies in the critically ill. In: Vincent JL (ed) Yearbook of Intensive Care and Emergency Medicine. Springer, Heidelberg, pp 629–637

    Google Scholar 

  2. Lorente JA, Garcia-Frade J, Landin L, et al (1993) Time course of hemostatic abnormalities in sepsis and its relation to outcome. Chest 103:1536–1542

    Article  PubMed  CAS  Google Scholar 

  3. Bone RC (1992) Sepsis and coagulation. An important link. Chest 101:594–595

    Article  PubMed  CAS  Google Scholar 

  4. Korte W, Truttmann B, Heim C, et al (1998) Preoperative values of molecular coagulation markers identify patients at low risk for perioperative haemostatic disorders and excessive blood loss. Clin Chem Lab Med 36:235–240

    Article  PubMed  CAS  Google Scholar 

  5. Gibbs NM, Crawford PM, Michalopoulos N (1992) Postoperative changes in coagulant and anticoagulant factors following abdominal aortic surgery. J Cardiothorac Vasc Anesth 6:680–685

    Article  PubMed  CAS  Google Scholar 

  6. Niemi TT, Kuitunen AH, Vahtera EM, Rosenberg PH (1996) Haemostatic changes caused by i.v. regional anaesthesia with hgnocaine. Br J Anaesth 76:822–828

    PubMed  CAS  Google Scholar 

  7. Thijs LG, de Boer JP, Groot MCM, et al (1993) Coagulation disorders in septic shock. Intensive Care Med 19:S8–S15

    Article  PubMed  Google Scholar 

  8. Stern DM, Esosito C, Gerlach H, et al (1991) Endothelium and regulation of coagulation. Diabetes Care 14(Suppl 1): 160–166

    Article  PubMed  CAS  Google Scholar 

  9. Wu KK (1992) Endothehal cells in hemostasis, thrombosis, and inflammation. Hosp Pract 27:145–166

    CAS  Google Scholar 

  10. Gerlach H, Esposito C, Stern D (1990) Modulation of endothehal hemostatic properties: an active role in the host response. Annu Rev Med 41:15–24

    Article  PubMed  CAS  Google Scholar 

  11. Mann KG, Krishnaswamy S, Lawson JH (1992) Surface-dependent hemostasis. Semin Hematol 29:213–226

    PubMed  CAS  Google Scholar 

  12. Maruyama I (1992) Thrombomodulin, an endothehal anticoagulant: its structure, function and expression. Jpn Circ J 56:187–191

    Article  PubMed  CAS  Google Scholar 

  13. Thompson EA, Salem HH (1987) The role of thrombomodulin in the regulation of hemostatic interactions. Progr Hematol 15:51–70

    CAS  Google Scholar 

  14. Esmon CT (1989) The roles of protein C and thrombomodulin in the regulation of blood coagulation. J Biol Chem 264:4743–4746

    PubMed  CAS  Google Scholar 

  15. Preissner KT (1988) Anticoagulant potential of endothehal cell membrane components. Haemostasis 18:271–306

    PubMed  CAS  Google Scholar 

  16. Ishii H, Uchiyama H, Kazama M (1991) Soluble thrombomodulin antigen in conditioned medium is increased by damage of endothehal cells. Thromb Haemost 65:618–623

    PubMed  CAS  Google Scholar 

  17. Dittman WA (1991) Thrombomodulin. Biological and cardiovascular applications. Trends Cardiovasc Med 1:331–336

    Article  PubMed  CAS  Google Scholar 

  18. Boldt J, Wollbrück T, Sonneborn S, Welters A, Hempelmann G (1995) Thrombomodulin in intensive care patients. Intensive Care Med 21:645–650

    Article  PubMed  CAS  Google Scholar 

  19. Amano K, Tateyama M, Inaba H, Fukutake K, Euimaki M (1992) Fluctuations in plasma levels of endothelin in patients with DIC. Thromb Haemost 68:404–406

    PubMed  CAS  Google Scholar 

  20. Ogawa S, Gerlach H, Esposito C, Pasagian-Macaulay A, Brett J, Stern D (1990) Hypoxia modulates the barrier and coagulant function of the cultured bovine endothelium: increased monolayer permeability and induction of procoagulant properties. J Clin Invest 85:1090–1098

    Article  PubMed  CAS  Google Scholar 

  21. Yamazaki M, Asakura H, Sato T, et al (1992) Changes in plasma levels of thrombomodulin during haemodialysis. Blood Coagul Fibrinolysis 3:113–117

    Article  PubMed  CAS  Google Scholar 

  22. Sakurabayashi I, Itou H, Ishii S, Kawai T, Ito H, Honma S (1985) Studies on granulocyte elastase in plasma. Jpn J Clin Hematol 33:1113–1118

    CAS  Google Scholar 

  23. Uchiyama H, Hiraishi S, Ishii H, Kazama M (1989) Plasma thrombomoduhn is originated by damage of endothelial cell. Thromb Haemost 62:276–280

    Google Scholar 

  24. Feindt P, Volkmer I, Seyffert UT, Haack H (1991) The role of protein C as an inhibitor of blood clotting during extracorporeal circulation. Thorac Cardiovasc Surgeon 39:338–343

    Article  CAS  Google Scholar 

  25. Bick RL (1992) Platelet function defects: a clinical review. Semin Thromb Hemost 18:167–185

    Article  PubMed  CAS  Google Scholar 

  26. Zilla P, Fasol R, Groscurth P, Klepetko W, Reichenspurner H, Wollner E (1989) Blood platelets in cardiopulmonary bypass. J Thorac Cardiovasc Surg 97:379–388

    PubMed  CAS  Google Scholar 

  27. Campbell FW, Addonizio VP jr (1988) Platelet function alterations during cardiac surgery. In: Ellison N, Jobes DR (eds) Effective Hemostasis in Cardiac Surgery. WB Saunders, Philadelphia, pp 105–109

    Google Scholar 

  28. Mammen EF, Koets MH, Washington BG (1985) Hemostasis changes during cardiopulmonary bypass surgery. Semin Thromb Hemost 11:281–292

    Article  PubMed  CAS  Google Scholar 

  29. Phillips DR, Charo IF, Parise LV, Fitzgerald LA (1988) The platelet membrane glycoprotein IIb-IIIa complex. Blood 71:841–843

    Google Scholar 

  30. Weiss HJ (1988) Antiplatelet drugs: Pharmacological aspects. In: Weiss HJ (ed) Platelets: Pathophysiology and Antiplatelet Drug Therapy. Alan R Liss, New York, pp 45–58

    Google Scholar 

  31. Sobel BE (1994) Intracranial bleeding, fibrinolysis, and anticoagulation. Circulation 90:2147–2152

    PubMed  CAS  Google Scholar 

  32. Fareed J, Bick RL, Hoppensteadt DA, Bermes EW (1995) Molecular markers of hemostatic activation: Applications in the diagnosis of thrombosis and vascular and thrombotic disorders. Clin Appl Thromb Hemost 1:87–102

    Article  Google Scholar 

  33. Levi M, ten Cate H, van der Poll T, et al (1993) Pathogenesis of disseminated intravascular coagulation in sepsis. JAMA 270:975–979

    Article  PubMed  CAS  Google Scholar 

  34. Born G, Cross M (1963) The aggregation of blood platelets. J Physiol 168:178–182

    PubMed  CAS  Google Scholar 

  35. Kundu SK, Heilman E, Sio R, et al (1996) Characterization of an in vitro function analyzer, PEA-100™. Clin Appl Thromb Hemost 2:241–249

    Article  Google Scholar 

  36. Mammen EF, Alshameeri RS, Comp PC (1995) Preliminary data from a field trial of the PFA-100 system. Semin Thromb Hemost 21(Suppl 2): 113–121

    PubMed  Google Scholar 

  37. Messmore HL, Walenga JM, Bick RL (1984) Molecular markers of platelet activation. Semin Thromb Hemost 19:264–269

    Article  Google Scholar 

  38. Spiess BD (1999) Maintenance of homeostasis in coagulation during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 13:2–5

    PubMed  CAS  Google Scholar 

  39. Miller BE, Guzzetta NA, Tosone SR, Levy JH (2000) Rapid evaluation of coagulopathies after cardiopulmonary bypass in children using modified thrombelastography. Anesth Analg 90: 1324–1330

    Article  PubMed  CAS  Google Scholar 

  40. Tuman KJ, McCarthy RJ, Djuric M, et al (1994) Evaluation of coagulation during cardiopulmonary bypass with a heparinase-modified thrombelastography assay. J Cardiothorac Vasc Anesth 8:144–149

    Article  PubMed  CAS  Google Scholar 

  41. Calatzis A, Haas S, G”dje O, et al (2000) Thrombelastographic coagulation monitoring during cardiovascular surgery with the ROTEG coagulation analyzer. In: Pifarr R (ed) Management of Bleeding in Cardiovascular Surgery. Hanley & Belfus, Philadelphia, pp 215–226

    Google Scholar 

  42. Leithäuser B, Matthias FR, Nicolai U, et al (1996) Hemostatic abnormalities and the severity of illness at the onset of clinically defined sepsis. Intensive Care Med 22:631–636

    Article  PubMed  Google Scholar 

  43. Scherer RU, Spangenberg P (1998) Procoagulant activity in patients with isolated severe head trauma. Crit Care Med 26:149–156

    Article  PubMed  CAS  Google Scholar 

  44. Boldt J, Papsdorf M, Rothe A, Kumle B, Piper S (2000) Changes of the hemostatic network in critically ill patients — is there a difference between sepsis, trauma, and neurosurgery patients? Crit Care Med 28:445–450

    Article  PubMed  CAS  Google Scholar 

  45. Okajiama K, Wang WP, Okabe H, et al (1991) Role of leukocytes in the activation of intravascular coagulation in patients with septicemia. Am J Hematol 36:265–271

    Article  Google Scholar 

  46. Bone RC (1992) Modulators of coagulation — a critical appraisal of their role in sepsis. Arch Intern Med 152:1381–1389

    Article  PubMed  CAS  Google Scholar 

  47. Philipe J, Offner F, Declerc PJ, et al (1991) Fibrinolysis and coagulation in patients with infectious disease and sepsis. Thromb Haemost 65:291–295

    Google Scholar 

  48. Voss R, Matthias FR, Borkowski G, et al (1990) Activation and inhibition of fibrinolysis in septic patients in an internal intensive care unit. Br J Haematol 75:99–105

    Article  PubMed  CAS  Google Scholar 

  49. Lorente JA, Garcia-Frade J, Landin L, et al (1993) Time course of hemostatic abnormalities in sepsis and its relation to outcome. Chest 103:1536–1542

    Article  PubMed  CAS  Google Scholar 

  50. Takahashi H, Tatewaki W, Wada K, et al (1990) Thrombin versus plasmin generation in disseminated intravascular coagulation associated with various underlying disorders. Am J Hematol 33:90–95

    Article  PubMed  CAS  Google Scholar 

  51. Chandler WL, Allessi MC, Aillaud MF, et al (1997) Clearance of tissue plasminogen activator (TPA) and TPA/plasminogen activator inhibitor type 1 (PAI-1) complex: relationship to elevated TPA antigen in patients with high PAI-1 activity levels. Circulation 96:761–768

    PubMed  CAS  Google Scholar 

  52. Boldt J, Menges T, Wollbrück M, Sonneborn S, Hempelmann G (1994) Platelet function in the critically ill. Chest 106:899–903

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. J. Boldt
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Intensive Care Erasme Hospital, Free University of Brussels, Route de Lennik 808, B-1070, Brussels, Belgium

    Jean-Louis Vincent (Head) (Head)

Rights and permissions

Reprints and permissions

Copyright information

© 2001 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Boldt, J. (2001). Changes of the Hemostatic Network in the Critically III. In: Vincent, JL. (eds) Yearbook of Intensive Care and Emergency Medicine 2001. Yearbook of Intensive Care and Emergency Medicine 2001, vol 2001. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-59467-0_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-59467-0_12

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-41407-0

  • Online ISBN: 978-3-642-59467-0

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation