Thromboelastography for evaluation of coagulopathy in nonbleeding patients with sepsis at intensive care unit admission

• DOI: 10.4103/ijccm.ijccm_72_17
• Publication Date: 2017-05-19T06:05:31Z
• Authors: Anupam Verma; Arvind Kumar Baronia; Ratender Kumar Singh; Syed Nabeel Muzaffar; Afzal Azim
• Keywords: Thromboelastography; Prothrombin time; Coagulation testing

IntroductIonSepsis is the manifestation of complex interactions between invading microorganisms and immune, inflammatory, coagulation responses host. [1]Coagulopathy in sepsis a risk factor for mortality.Conventional assays (CCAs) include prothrombin time/international normalized ratio (INR), activated partial thromboplastin time (aPTT), platelet count (PLT), fibrinogen.CCAs are routinely used to diagnose disorders also guide transfusion practices.However, CCAs have many limitations. [2]These tests do not evaluate whole process as they done plasma without cellular component (platelets tissue bearing cells) blood.Besides, fail hypercoagulable states fibrinolytic system.To overcome these shortcomings, global such thromboelastography (TEG) rotational thromboelastometry (ROTEM) emerged which analyze blood (both components) closely resemble vivo hemostasis.They define elaborately dynamics clot formation (development, stabilization, dissolution clot). [3]Both TEG ROTEM provide pertinent information about adhesiveness, elasticity, Background: Thromboelastography test analyzes process.TEG popular trauma, liver transplant, cardiac surgeries, but studies limited.We assessed utility evaluating coagulopathy nonbleeding patients with sepsis.Materials Methods: A prospective, observational study was 12-bedded Intensive Care Unit (ICU) tertiary care hospital North India, during May 2014-November 2014.After ethical clearance, all at ICU admission were included study.Exclusion criteria age <18 years, plasma/platelet before admission, on oral antiplatelets/anticoagulants, or underlying hematological disorders.At samples analyzed by kaolin-based analyzer within an hour collecting 2.7 ml citrated from arterial line.TEG parameters reaction (R), K (K), alpha angle (α), maximum amplitude (MA), index (CI), lysis (LY 30).Results: In TEG, mean values R, K, α, MA, CI, LY30 6.45 ± 2.59 (min), 1.67 0.96 66.37 10.44 ( 0 ), 67.08 10.33 (mm), 0.63 3.46, 2.23 4.08 (%), respectively.In conventional assay (CCA), international platelet, fibrinogen 1.63 0.57, 153.96 99.16 (×10 3 /mm 301.33 112.82 (mg/dl), those deranged INR (INR ≥1.6), 60% normocoagulable 20% hypercoagulable.Similarly, 81% thrombocytopenia (platelet <1,00,000/µL) normocoagulable.Conclusion: could differentiate among normocoagulant, hypocoagulant, hypercoagulant (unlike CCAs).Patients septic shock had trend toward hypocoagulant state while state.