Risks and Benefits of Activated Protein C Treatment for Severe Sepsis

A new hypothesis with implications for the treatment of sepsis has recently been tested — the hypothesis that part of the pathophysiology of sepsis is caused by unrestricted or inappropriate coagulation in the microcirculation. Three agents that block coagulation at different stages have now been evaluated in large, multicenter trials as adjunctive therapy for sepsis. Neither antithrombin III nor tissue-factor-pathway inhibitor was effective in patients with severe sepsis or septic shock.1,2 In contrast, treatment with activated protein C (drotrecogin alfa [activated]) was associated with a significant reduction in 28-day mortality. Of the patients who received activated protein C, 24.7 . . .