Thromboelastometry as a supplementary tool for evaluation of hemostasis in severe sepsis and septic shock

• Published in: Acta anaesthesiologica Scandinavica Vol. 58; no. 5; pp. 525 - 533
• Main Authors: ANDERSEN, M. G., HVAS, C. L., TØNNESEN, E., HVAS, A-M.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-05-2014; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Anticoagulants - administration & dosage; Anticoagulants - therapeutic use; Blood Cell Count; Blood Coagulation Tests; Blood Component Transfusion - utilization; Critical Care - methods; Disseminated Intravascular Coagulation - blood; Disseminated Intravascular Coagulation - drug therapy; Disseminated Intravascular Coagulation - etiology; Drug therapy; Female; Fibrin Fibrinogen Degradation Products - analysis; Fibrinogen - analysis; Hemorrhage - etiology; Hemorrhage - therapy; Hemorrhagic Disorders - diagnosis; Hemorrhagic Disorders - etiology; Hemorrhagic Disorders - therapy; Hemostasis; Humans; Intensive care; Male; Middle Aged; Prospective Studies; Sepsis; Sepsis - blood; Sepsis - complications; Severity of Illness Index; Shock, Septic - blood; Shock, Septic - complications; Thrombelastography; Thrombin - analysis; Thrombin - biosynthesis; Thrombophilia - diagnosis; Thrombophilia - drug therapy; Thrombophilia - therapy
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/aas.12290

Background
Sepsis leads to disruption of hemostasis, making early evaluation of coagulation essential. The aim of this study was to provide a detailed investigation of coagulation and the use of blood products in patients with severe sepsis or septic shock, admitted to a multidisciplinary intensive care unit.
Methods
Thirty‐six patients with severe sepsis or septic shock were included in this prospective observational study. Blood samples and information on transfusion of blood products were obtained for up to 3 consecutive days, and day 7 if the patient was still in the intensive care unit. Thromboelastometry (ROTEM®), analyses of thrombin generation, and conventional coagulation tests were performed.
Results
ROTEM® revealed an overall normo‐coagulable state among patients with severe sepsis or septic shock. Conventional coagulation analyses showed divergent results with hypercoagulable trends in terms of reduced antithrombin and acute phase response with increased fibrinogen and fibrin d‐dimer, and on the other hand, coagulation disturbances with a decreased prothrombin time and prolonged activated partial thromboplastin time. This hypocoagulabe state was supported by a delayed and reduced thrombin generation. Twelve patients experienced 21 independent transfusion episodes with fresh frozen plasma. Of these, only five (22%) transfusions were performed because of active bleeding.
Conclusion
ROTEM® demonstrated an overall normo‐coagulation, whereas the conventional coagulation tests and thrombin generation analyses mainly reflected hypocoagulation. Given the dynamic and global features of ROTEM®, this analysis may be a relevant supplementary tool for the assessment of hemostasis in patients with severe sepsis or septic shock.