Endotoxinemia-induced changes in coagulation as measured by rotation thrombelastometry technique and conventional...

Modified rotation thrombelastometry (ROTEM) is widely used in near-patient assessment of hemostasis, but data on functional consequences initiated by acute endotoxinemia are rare. To test the hypothesis that the ROTEM technique allows detection of endotoxinemia-induced changes in hemostasis, we conducted a pilot study on pigs. Fifteen healthy pigs were anesthetized and instrumented for invasive hemodynamic monitoring. Several coagulation tests and the ROTEM assay were performed at baseline and 60 min after administration of a bolus of 200 microg of Escherichia coli lipopolysaccharide followed by a continuous infusion of 0.1 microg/kg per min. After induction of acute endotoxinemia, clot formation time increased (P = 0.001), and alpha angle (P = 0.001) and maximum clot firmness decreased significantly (P = 0.001) in intrinsically and extrinsically activated ROTEM assays. Moreover, fibrinogen/fibrin polymerization showed significantly lower values during endotoxinemia (P = 0.001), and coagulation time shortened for the intrinsically activated assay (P = 0.017). Simultaneously, a significant decrease in platelet count (P = 0.001), fibrinogen (P = 0.001), antithrombin and protein C (P = 0.001) was registered, whereas results of standard coagulation tests and D-dimers showed no significant changes although thrombin-antithrombin complex increased (P = 0.001). Wilcoxon Z score analysis showed that changes in ROTEM variables were comparable to changes in antithrombin, protein C, platelet count, white blood cells and fibrinogen concentrations. The ROTEM assays were able to reflect endotoxinemia-dependent changes in the hemostatic system in pigs early by showing not only activation but also signs of consumption, whereas results of routine coagulation tests remained unchanged.