Should all septic patients be given systemic anticoagulation? No

Excerpt

According to current guidelines [1], all patients who are admitted to the intensive care unit (ICU) with sepsis/septic shock should receive some form of anticoagulant prophylaxis to decrease the risk of deep venous thrombosis and venous thromboembolism (VTE). This VTE prophylaxis usually comes in the form of low dose, systemic anticoagulation to prevent new thrombus formation. Such a dosing strategy is generally applied with unfractionated or low molecular weight heparin, supplemented with venous intermittent compression devices when feasible, or replaced by injectable direct thrombin inhibitors if heparin-induced thrombocytopenia develops. A new generation of oral direct inhibitors of factor Xa or thrombin are now available as VTE preventive agents [2]. Experience of these agents in septic patients is limited and will need to be carefully studied to determine if they could be a new alternative to existing methods of coagulation inhibition. Low dose heparin is intended to prevent new thrombus formation without necessarily clearing existing intravascular clots. High dose therapeutic levels of heparin are needed to clear thrombi but add an attendant risk of causing excess bleeding. …