Microcirculatory disorders in sepsis and transplantation: therapy with natural coagulatory inhibitors antithrombin and activated protein C.
Curr Opin Crit Care
; 12(5): 426-30, 2006 Oct.
Article
en En
| MEDLINE
| ID: mdl-16943720
ABSTRACT
PURPOSE OF REVIEW Modern technologies allow visualization of microcirculatory disorders. This review describes how the coagulatory inhibitors antithrombin and activated protein C (APC) can improve microcirculation in sepsis and transplantation. RECENT FINDINGS:
The effects of antithrombin and APC on microcirculatory disorders in ischemia reperfusion and experimental sepsis have been reported recently. In addition, antithrombin has recently been clinically used to reduce graft pancreatitis after pancreas-kidney transplantation, and to improve kidney perfusion. It was demonstrated that septic capillary perfusion failure as well as leukocyte-endothelial cell interactions can be reversed by high-dose prophylactic antithrombin application. APC was also highly effective in this context. Thus, APC could improve microcirculatory blood flow in septic patients as recently measured by in-vivo orthogonal polarization spectral imaging techniques. For antithrombin, comparable measurements in humans are currently not available.SUMMARY:
Microcirculatory dysfunction plays a key role in the development of organ dysfunction in septic patients and after solid organ transplantation. The exogenous application of coagulatory inhibitors may provide a new important strategy for prevention and treatment of microcirculatory disorders. This mode of action may be the reason why coagulatory inhibitors could improve mortality in septic patients without directly influencing inflammatory mediator concentrations.
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Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Proteína C
/
Antitrombinas
/
Trasplante de Órganos
/
Sepsis
/
Microcirculación
/
Anticoagulantes
Tipo de estudio:
Prognostic_studies
Límite:
Animals
/
Humans
Idioma:
En
Revista:
Curr Opin Crit Care
Asunto de la revista:
TERAPIA INTENSIVA
Año:
2006
Tipo del documento:
Article
País de afiliación:
Alemania