Thromboelastometry in critically ill patients with disseminated intravascular coagulation

Area of Science:

• Critical Care Medicine
• Hematology
• Diagnostic Tools

Background:

• Coagulopathy is common in critically ill patients, often due to disseminated intravascular coagulation (DIC).
• Current diagnostic methods lack in-vivo hemostatic profile reflection.
• Rotational thromboelastometry (ROTEM) may differentiate hypocoagulable and hypercoagulable states, potentially identifying DIC.

Purpose of the Study:

• To evaluate the diagnostic capability of thromboelastometry in detecting DIC.
• To compare ROTEM parameters with coagulation markers and natural anticoagulants in DIC patients.

Main Methods:

• Subgroup analysis of a clinical trial involving critically ill patients with coagulopathy.
• Measurement of ROTEM parameters, coagulation markers, and natural anticoagulants.
• Receiver operator characteristic (ROC) analysis to assess discriminatory ability.

Main Results:

• Thirteen of 23 patients met criteria for overt DIC.
• DIC patients showed lower platelet counts, fibrinogen, factors II, VII, VIII, antithrombin, protein C, and S.
• EXTEM CFT, alpha angle, and MCF on ROTEM discriminated between DIC and non-DIC patients.
• Combining ROTEM with protein C or antithrombin improved diagnostic performance.

Conclusions:

• ROTEM profiles were more hypocoagulable in DIC patients.
• ROTEM correlates with the ISTH DIC score.
• ROTEM, especially when combined with antithrombin or protein C, is a potentially valuable tool for diagnosing DIC in critically ill patients.