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.
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.
Authors: Annalisa Boscolo; Luca Spiezia; Elena Campello; Elisabetta Maria Consolaro; Carlo Ori; Paolo Simioni Journal: Intern Emerg Med Date: 2019-07-02 Impact factor: 3.397
Authors: Gareth R Davies; Suresh Pillai; Matthew Lawrence; Gavin M Mills; Robert Aubrey; Lindsay D'Silva; Ceri Battle; Rhodri Williams; Rowan Brown; Dafydd Thomas; Keith Morris; Phillip Adrian Evans Journal: Intensive Care Med Date: 2016-09-03 Impact factor: 17.440
Authors: Tomaz Crochemore; Flavia Nunes Dias Campos; Camila Menezes Souza Pessoa; Leonardo Lima Rocha; Pedro Paulo Zanella do Amaral Campos; Thiago Domingos Corrêa Journal: Clin Case Rep Date: 2017-03-31
Authors: Matej Samoš; Lucia Stančiaková; Lukáš Duraj; František Kovář; Marián Fedor; Radoslava Šimonová; Tomáš Bolek; Peter Galajda; Ján Staško; Peter Kubisz; Marián Mokáň Journal: Medicine (Baltimore) Date: 2017-02 Impact factor: 1.889
Authors: Thomas Decker Christensen; Henrik Vad; Søren Pedersen; Kåre Hornbech; Nora Elisabeth Zois; Peter B Licht; Mads Nybo; Anne-Mette Hvas Journal: PLoS One Date: 2017-02-15 Impact factor: 3.240
Authors: Thomas Decker Christensen; Henrik Vad; Søren Pedersen; Peter B Licht; Mads Nybo; Kåre Hornbech; Nora Elisabeth Zois; Anne-Mette Hvas Journal: Thromb J Date: 2017-12-20