Vascular bed-specific hemostasis: Role of endothelium in... : Critical Care Medicine (original) (raw)

SCIENTIFIC REVIEWS

Vascular bed-specific hemostasis: Role of endothelium in sepsis pathogenesis

From Harvard Medical School and Beth Israel Medical Center, Boston, MA.

Presented, in part, at the Margaux Conference on Critical Illness, Margaux, France, November 8–12, 2000.

Address requests for reprints to: William C. Aird, MD, Beth Israel Deaconess Medical Center, RW-663, 330 Brookline Avenue, Boston, MA 02215. E-mail: [email protected]

Sepsis-induced activation of coagulation is initiated through the extrinsic pathway and is dependent on cross-talk and feedback.

Abstract

Objectives

To examine the role of vascular bed-specific pathways in determining the hemostatic phenotype in sepsis.

Data Sources/Study Selection

Published research and review articles related to hemostasis and endothelial cell biology.

Data Extraction and Synthesis

The results of published studies have been used to generate a hypothesis of vascular bed-specific hemostasis in sepsis.

Conclusions

In sepsis, coagulation is initiated by the extrinsic pathway and is amplified through the intrinsic pathway. In addition, the body’s natural anticoagulant mechanisms are significantly dampened. Together, these changes result in a net imbalance of hemostasis. The nature of this imbalance varies from one vascular bed to the next according to the local set point of the endothelium. These concepts lay an important foundation for understanding the pathophysiology of sepsis.