Coagulation activation during sepsis: role of protein C system

It is now clear that severe sepsis implies not only inflammation, but also coagulation and apoptosis, these 3 components being closely dependent. Our knowledge in sepsis physiopathology, these last years, led to test new treatments, in particular in the field of coagulation. Thus, a phase III clinical trial testing the efficiency of an anticoagulant protein, activated protein C (APC), as treatment of the severe sepsis, gave promising results. APC belongs to a system implying plasmatic proteins and endothelial cells receptors. Besides their well documented effects on coagulation, the actors of PC system are endowed for some anti-inflammatory activity, and for the others antiapoptotic effect. These properties let think that the state of functioning of this system could play a role determining in the development of the severe sepsis. While it was admitted that the severe sepsis was associated with a loss of the capacities of activation of PC in APC, a recent study showing that more than half of the patients having a sepsis severe can activate their PC, tends to rehabilitate the idea of the possible use of PC not activated in the treatment of this pathology.