Anest. intenziv. Med. 2016;27(6):358-363

Management of sepsis-induced disseminated intravascular coagulopathy using antithrombin and heparin, and the use of thromboelastometry in establishing the diagnosis of heparin resistanceIntesive Care Medicine - Case Report

M. Durila^1,*, P. Salaj², H. Součková³, M. Astraverkhava¹, J. Beroušek¹

¹ Klinika anesteziologie, resuscitace a intenzivní medicíny, 2. LF UK a FN Motol, Praha

² Ústav hematologie a krevní tranfuze, Centrum pro trombózu a hemostázu, Praha

³ Gynekologicko-porodnická klinika, 2. LF UK a FN Motol, Praha

Severe sepsis is often accompanied by disseminated intravascular coagulation (DIC) and multiple organ dysfunction. Increased activation of coagulation is characteristic for this syndrome and therefore, from the pathophysiological point of view, it would be logical to intervene at the initiation of coagulation by the administration of antithrombin and heparin. Evidence from randomized studies offering clear instructions on the usage of these drugs is lacking though. In our case report we describe the management of septic DIC with antithrombin and heparin without bleeding complication. We have found that in order to stop the consumption of the coagulation blood components, it is required to maintain antithrombin levels above 90%. Because of the high risk of heparin resistance in sepsis it is appropriate to monitor the level of heparin with anti Xa with the aim of 0.5-0.6.

Keywords: antithrombin; heparin; heparin resistance; disseminated intravascular coagulation; thromboelastometry

Received: July 28, 2016; Accepted: September 16, 2016; Published: December 1, 2016  Show citation