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Updated: Jul 28, 2025
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Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization
Published on: June 4, 2020
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Uncovering hypercoagulation status using rotational thromboelastometry in patients with sepsis presented with
H-D Bui-Thi1, D-K Nguyen, G-K To
1Department of Intensive Care, University Medical Center Ho Chi Minh City, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam. khoi.lm@umc.edu.vn.
Summary
Rotational thromboelastometry (ROTEM) accurately identifies hypercoagulation in sepsis patients, unlike conventional tests. Elevated fibrinogen levels are a key driver of this sepsis-induced hypercoagulability.
Area of Science:
- Critical Care Medicine
- Hematology
- Sepsis Pathophysiology
Background:
- Conventional coagulation tests (CCTs) often fail to detect hypercoagulation in sepsis patients.
- CCTs may lead to overdiagnosis of hypocoagulation, resulting in unnecessary blood transfusions.
Purpose of the Study:
- To utilize rotational thromboelastometry (ROTEM) for classifying coagulation status in sepsis patients with abnormal CCTs.
- To identify key coagulation components influencing coagulation status in sepsis.
Main Methods:
- Observational study of 161 sepsis patients (Sepsis-3 criteria).
- Concurrent CCTs and ROTEM assessments within 24 hours of ICU admission.
- Data extracted from patients with abnormal CCTs (aPTT ratio, INR, platelet count, fibrinogen).
Main Results:
- ROTEM identified hypercoagulation in sepsis patients initially diagnosed with hypocoagulation by CCTs.
- Hypercoagulability was linked to increased maximum clot firmness and significantly higher plasma fibrinogen concentrations.
- Specific findings included 11.8% hypercoagulation in patients with INR ≥1.6 and 3.5% in those with low platelet counts.
Conclusions:
- ROTEM effectively detects hypercoagulability missed by CCTs in sepsis.
- Hyperfibrinogenemia is a significant contributor to hypercoagulation in sepsis patients.
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