The effect of sepsis and septic shock on the viscoelastic properties of clot quality and mass using rotational thromboelastometry: a prospective observational study
Davies, Gareth R.
Evans, Philip Adrian
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Purpose: The study purpose was to define changes in coagulation across the sepsis spectrum using rotational thromboelastometry (ROTEM).Methods: Sepsis patients were recruited on admission to the Emergency Department and Intensive Care Units of a large teaching hospital in Wales. ROTEM markers of clot development and fibrinolysis were determined, as well as standard coagulation markers. A healthy control group matched for age and gender was also recruited (n = 44). Results: 100 patients were recruited (50 sepsis, 20 severe sepsis and 30 septic shock). Maximum clot firmness was significantly higher in the sepsis (p < 0.001) and severe sepsis (p = 0.012) groups than the healthy control (71.6 ± 4.5 and 70.4 ± 4.1 vs 64.4 respectively). In septic shock there was prolonged clot development; however, maximum clot firmness remained normal. Fibrinolytic function was significantly impaired in septic shock, which was also significantly associated with 28-day mortality (p < 0.001). Conclusions: ROTEM indicated significantly enhanced clot structural development in sepsis and severe sepsis, which could be indicative of a hypercoagulable phase. In septic shock, despite there being a prolongation of clotting pathways and impaired fibrinolysis, clot mass was comparably normal, suggestive of the development of a clot with healthy characteristics.
Journal of Critical Care;
Davies, G.R., Lawrence, M., Pillai, S., Mills, G.M., Aubrey, R., Thomas, D., Williams, R., Morris, K. and Evans, P.A. (2018) 'The effect of sepsis and septic shock on the viscoelastic properties of clot quality and mass using rotational thromboelastometry: A prospective observational study', Journal of Critical Care, 44, pp.7-11. DOI:10.1016/j.jcrc.2017.09.183.
Article published in Journal of Critical Care on 02 October (online), available at: https://doi.org/10.1016/j.jcrc.2017.09.183.
Cardiff Metropolitan University (Grant ID: Cardiff Metropolian (Internal))
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