Sepsis-induced coagulopathy and disseminated intravascular coagulation


  • Antonino Giarratano Dipartimento di Emergenza Urgenza AUOP “Giaccone”, UOC Anestesia e Rianimazione e Terapia del Dolore, A.O.U. Policlinico “P. Giaccone” Palermo, Università degli Studi di Palermo - Italy



Coagulopathy, Disseminated Intravascular Coagulation, Hemorrhage, Organ Dysfunction Scores, Sepsis, Sepsis-Induced Coagulopathy


 The definition of sepsis is usually associated to the innate immune system while instead, it is also connected to a response of the coagulation system, given that in septic patients thrombohemorrhagic events occur. The activation of the immune response and the recruitment of the coagulation system aim at the compartmentalization in the vascular stream of the response to the microorganism to avoid its spreading. This mechanism, as a side effect, exposes the organism to a variety of “dysregulations”. Disseminated Intravascular Coagulation (DIC) can present itself in septic patients with one of three different phenotypes: pro-coagulant, fibrinolytic and hemorrhagic. Associated to DIC, as it can be considered its predecessor, is Sepsis-Induced Coagulopathy (SIC) a prior, faster-evolving condition. International institutions have developed a scoring system to distinguish SIC from overt-DIC, which has the distinctive characteristics of a reduced platelet count in the initial stages and a higher INR value. Being a rapidly evolving condition SIC needs to be quickly diagnosed and treated; to this day no concrete recommendations exist regarding a therapeutic approach. Unfractionated heparin, antithrombin III, thrombomodulin and recombinant protein C have shown limited, or even non-existing, effects in SIC treatment, while the use of thromboelastography and thromboelastometry has represented a progress in the testing of coagulation-hemorrhagic conditions. The procedure to be followed is, besides microcirculation resuscitation, a prompt intervention with antibiotic treatment and the execution of a de-escalation protocol. Further studies are still necessary to define the most effective treatment for these conditions.


Wada H, Matsumoto T, Yamashita Y. Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines. J Intensive Care. 2014;2(1):15. PMID:25520831 DOI:

Iba T, Levy JH. Sepsis-induced Coagulopathy and Disseminated Intravascular Coagulation. Anesthesiology. 2020;132(5):1238-1245. DOI:

Iba T, Levy JH, Raj A, Warkentin TE. Advance in the Management of Sepsis-Induced Coagulopathy and Disseminated Intravascular Coagulation. J Clin Med. 2019;8(5):728. PMID:31121897 DOI:

de Waele J, Martin-Loeches I. Advances in source control in patients with sepsis and septic shock. ICU Manag Pract. 2018;18(3):171-174. Online (Accessed June 2022)

Jaimes F, De La Rosa G, Morales C, et al. Unfractioned heparin for treatment of sepsis: A randomized clinical trial (The HETRASE Study). Crit Care Med. 2009;37(4):1185-1196. PMID:19242322 DOI:

Warren BL, Eid A, Singer P, et al. High-Dose Antithrombin III in Severe Sepsis. A Randomized Controlled Trial. JAMA. 2001;286(15):1869-1878. PMID:11597289 DOI:

Vincent JL, Francois B, Zabolotskikh I, et al; SCARLET Trial Group. Effect of a Recombinant Human Soluble Thrombomodulin on Mortality in Patients With Sepsis-Associated Coagulopathy: The SCARLET Randomized Clinical Trial. JAMA. 2019;321(20):1993-2002. PMID:31104069 DOI:

Ranieri VM, Thompson BT, Barie PS, et al; PROWESS-SHOCK Study Group. Drotrecogin alfa (activated) in adults with septic shock. N Engl J Med. 2012;366(22):2055-2064. PMID:22616830 DOI:



How to Cite

Giarratano A. Sepsis-induced coagulopathy and disseminated intravascular coagulation. AboutOpen [Internet]. 2022 Jul. 31 [cited 2023 May 31];9(1):58-60. Available from:



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