Perturbations of the clotting system frequently accompany systemic inflammatory states. Coagulation abnormalities, specifically an imbalance between coagulant and anticoagulant mechanisms, are a frequent occurrence in patients with septic shock and trauma and have been associated with an increased mortality. The major clinical manifestation is the disseminated intravascular coagulation syndrome (DIC), which is characterized by a systemic activation of the blood coagulation system with deposition of fibrin in various organs, consumption and subsequent exhaustion of coagulation proteins and platelets, something that may induce severe bleeding complications. Replacement of some of these proteins in patients with sepsis may improve the coagulation defects and other features of organ dysfunction. Clinical studies with antithrombin III and protein C have suggested beneficial effects on variables of coagulation and final outcome (mostly the replacement of the second protein).
Severe trauma is another clinical condition frequently associated with coagulation defects. A combination of mechanisms, including release of tissue material in the circulation, activation of fibrinolysis, along with acidosis and hypothermia may contribute to the impairment of hemostasis at various levels. New, promising approaches in order to prevent or reverse traumatic coagulopathy include the application of the ‘damage control’ surgical strategy and the use of recombinant activated factor VII. This last pharmacological approach may be indicated to stop blood loss from small interrupted vessels, the so-called non-mechanical bleeding.