How to manage coagulopathies in critically ill patients
Julie Helms 1 2, Toshiaki Iba 3, Jean Marie Connors 4, Satoshi Gando 5 6, Marcel Levi 7 8, Ferhat Meziani 9 10, Jerrold H Levy 11
1) Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, 1, place de l’Hôpital, 67091, Strasbourg Cedex, France. Julie.helms@chru-strasbourg.fr.
2) INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France. Julie.helms@chru-strasbourg.fr.
3) Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
4) Hematology Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA.
5) Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, USA.
6) Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan.
7) Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
8) Department of Medicine, University College London Hospitals NHS Foundation Trust, and Cardio-Metabolic Programme-NIHR UCLH/UCL BRC London, London, UK.
9) Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, 1, place de l’Hôpital, 67091, Strasbourg Cedex, France.
10) INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.
11) Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA.
Coagulopathy is a severe and frequent complication in critically ill patients, for which the pathogenesis and presentation may be variable depending on the underlying disease. Based on the dominant clinical phenotype, the current review differentiates between hemorrhagic coagulopathies, characterized by a hypocoagulable and hyperfibrinolysis state, and thrombotic coagulopathies with a systemic prothrombotic and antifibrinolytic phenotype. We discuss the differences in pathogenesis and treatment of the common coagulopathies.