Table 2.

Pathogenesis of disseminated intravascular coagulation in sepsis.

Mechanism	Pathophysiology
1) Increased thrombin generation	Mediated predominantlyby tissue factor/factor VIIa pathway
2) Impaired function of physiological anticoagulant pathway
a) Reduction of antithrombin levels	The result of a combination of increased consumption, enzyme degradation, impaired liver synthesis and vascular leakage
b) Depression of protein C system	The result of a combination of increased consumption, impaired liver synthesis, vascular leakage and down- regulation of thrombomodulin
c) Insufficienttissue factor pathway inhibitor (TFPI)
3) Impaired fibrinolysis	Mediated by release of plasminogen activators from endothelial cells immediately followed by an increase in the plasma levels of plasminogen activator inhibitor type 1 (PAI-1)
4) Activation of inflammatory pathway	Mediated by activated coagulation proteins and by depression of the protein C system