Effets hémodynamiques de la protéine C activée dans le choc septique

Recombinant human activated protein C (APC) has been demonstrated to reduce the mortality rate of adult patients with severe sepsis. This effect was thought to be related to its anticoagulant and anti-inflammatory processes in severe sepsis. Indeed, data from the Prowess study demonstrated that the use of APC was associated with a quicker reduction in cardiovascular failure. Recent animal data have suggested that APC may improve both vascular and myocardial dysfunction and vascular reactivity to catecholamines during endotoxin and/or septic challenges. These effects appear to be related to an attenuation of endothelial cell-leukocyte activation and to a marked reduction in inflammation and oxidative stress at both the vascular and cardiac level.