Are thromboelastometric and thromboelastographic parameters associated with mortality in septic patients? A systematic review and meta-analysis

Boscolo, Annalisa; Spiezia, Luca; Cassai, Alessandro De; Pasin, Laura; Pesenti, Elisa; Zatta, Matteo; Zampirollo, Stefano; Andreatta, Giulio; Sella, Nicolò; Pettenuzzo, Tommaso; Rose, Kirstin E.; Simioni, Paolo; Navalesi, Paolo

doi:10.1016/j.jcrc.2020.09.034

Cited by 13 publications

(7 citation statements)

References 46 publications

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“…Conventional hemagglutination is a part of the overall coagulation process and is a microscopic reflection of some of the coagulation factor activity and is also used to determine coagulation function conventional assays that cannot assess the entire dynamic changes in blood coagulation [ 6 ]. In contrast, the thromboelastograph (TEG) has a significant role in real-time monitoring of the time and rate of clot formation, the hardness and stability of clot formation, and objectively evaluating the aggregation function of platelets, which is more prominent in clinical treatment [ 7 , 8 ]. TEG dynamically reflects the whole process of coagulation cascade reaction by rapidly assessing the physical properties of clots and can detect both the bleeding status and thrombus and prethrombotic status, and it is now widely used in various clinical departments [ 9 ].…”

Section: Prefacementioning

confidence: 99%

Study of the Significance of Thromboelastography Changes in Patients with Dyslipidemia

Lin

Yang

Ruan

et al. 2022

Emergency Medicine International

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Purpose. To investigate the changes in thromboelastography (TEG) in patients with dyslipidemia to study its effect on the blood coagulation status. Methods. 131 patients hospitalized in Fujian Provincial Jinshan Hospital from January 2018 to December 2020 were selected, and 64 cases in the hyperlipidemia (HL) group and 67 cases in the non-HL group were set according to whether their blood lipids were abnormal. By measuring the changes of each parameter of TEG in patients, the relevant parameters R value, K value, α angle, and MA value were calculated. And routine blood coagulation (PT, APTT, INR, FIB, and TT) and routine blood (platelet count) tests were performed on all study subjects to analyze the changes of each index of the coagulation function and each parameter of TED in both groups and explore the clinical value of TEG on HL diseases. Results. Compared with the non-HL group, R and K values decreased, and angle and MA values increased in the HL group ( P < 0.05 ). PT, APTT, and INR values decreased, and FIB values increased in the HL group compared with the nonhyperlipidemic group ( P < 0.05 ). The TT levels were similar in the non-HL group and the HL group ( P > 0.05 ). Compared with the non-HL group, PLT values decreased, and PDW and MPV values increased in the HL group ( P < 0.05 ). R value was positively correlated with APTT, r= 0.373, P = 0.002 . K value was negatively correlated with PLT, r= −0.399, P = 0.002 . α angle and MA values were positively correlated with PLT, r= 0.319/0.475, P = 0.010 / P < 0.001 . The rest of the indexes did not correlate with each parameter of TEG significant correlation. Conclusion. TEG can predict the hypercoagulability and hypocoagulability of blood by the changes of R value, K value, α angle, and MA to evaluate the effect of hyperlipidemia on the coagulation status, which is important for guiding the adjustment of lipid-lowering, antithrombotic, and anticoagulation programs in patients with atherosclerosis combined with hyperlipidemia or postsurgery combined with hyperlipidemia.

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Section: Prefacementioning

confidence: 99%

Study of the Significance of Thromboelastography Changes in Patients with Dyslipidemia

Lin

Yang

Ruan

et al. 2022

Emergency Medicine International

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“…Moreover, although patients had normal platelet count and fibrinogen level, the EXTEM may display a hypocoagulable profile (Table 2). This may be explained by the impaired platelet aggregation and fibrinogen function, which frequently manifest in sepsis (11,12,36,37). Thus far, the contribution of both quantitative and functional platelets to clot strength was involved in ROTEM but eliminated in the standard assay.…”

Section: Discussionmentioning

confidence: 99%

“…The ongoing excessive consumption of coagulation factors ultimately results in a hypocoagulable state with a high risk of severe hemorrhagic complications (2,4,5). Previous studies have reported that the early phase of sepsis is characterized by hypercoagulability, whereas the later stages (severe sepsis or septic shock) trend toward hypocoagulability and are associated with increased morbidity and mortality (1,(6)(7)(8)(9)(10)(11)(12). Therefore, proper identification of the coagulation profile is pivotal for appropriate treatment and prognosis.…”

Section: Introductionmentioning

confidence: 99%

“…Hence, methodological improvements in thromboelastography (TEG) or rotational thromboelastometry (ROTEM) have been widely utilized as point-of-care tests for optimal hemostatic resuscitation in patients with sepsis. These tests measure dynamic global clotting and overcome limitations of the conventional assay in discriminating between hyper-and hypocoagulability (10)(11)(12)17). Hypocoagulable profile in viscoelastic parameters is associated with poor outcomes (11); therefore, clinicians should monitor the patients more strictly and adopt adequate diagnostic and therapeutic strategies earlier.…”

Section: Introductionmentioning

confidence: 99%

“…These tests measure dynamic global clotting and overcome limitations of the conventional assay in discriminating between hyper-and hypocoagulability (10)(11)(12)17). Hypocoagulable profile in viscoelastic parameters is associated with poor outcomes (11); therefore, clinicians should monitor the patients more strictly and adopt adequate diagnostic and therapeutic strategies earlier. Furthermore, the efficacy of the viscoelastic test for the guidance of blood transfusion practice has been reported (15,16).…”

Section: Introductionmentioning

confidence: 99%

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Hypocoagulable Tendency on Thromboelastometry Associated With Severity and Anticoagulation Timing in Pediatric Septic Shock: A Prospective Observational Study

et al. 2021

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Objective: To identify whether coagulation profiles using thromboelastometry are associated with outcomes in pediatric septic shock. The primary outcomes were the development of disseminated intravascular coagulation (DIC) and the severity of the pediatric intensive care unit (PICU) existing scoring systems, while the secondary outcome was hospital mortality. This study aimed to contribute to current findings of the limitations of conventional tests in determining the optimal timing of anticoagulation in sepsis.Design: A prospective, observational study conducted between August 2019 and August 2020.Setting: PICU at a pediatric tertiary hospital in Hanoi, Vietnam.Patients: Fifty-five pediatric patients who met the septic shock criteria were enrolled.Measurements and Main Results: Fifty-five patients with septic shock were recruited. At the time of diagnosis, thromboelastometry revealed normocoagulability, hypercoagulability, and hypocoagulability in 29, 29, and 42% of the patients, respectively (p > 0.05); however, most patients in the overt DIC and non-survival groups progressed to hypocoagulability (82 and 64%, respectively). The overt DIC, PELOD-2 > 8, PRISM-III > 11, and non-survival group had a significant hypocoagulable tendency according to thromboelastometry parameters [prolonged clotting time (CT) and clot formation time (CFT); and reduced α-angle (α), maximum clot firmness (MCF), thrombodynamic potential index (TPI)] compared to the non-overt DIC, PELOD-2 ≤ 8, PRISM-III score ≤ 11 and survival group (p < 0.05). Conventional parameters between the normocoagulable and hypercoagulable groups were not different (p > 0.05). Hypocoagulability was characterized by lower platelet count and fibrinogen level, higher prolonged prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (APTT), and higher D-dimer level than in hypercoagulability (p < 0.05). Hypocoagulable tendency on thromboelastometry had a higher hazard at a PT > 16.1 s [area under the curve (AUC) = 0.747, odds ratio (OR) = 10.5, p = 0.002], INR > 1.4 (AUC = 0.754, OR = 6.9, p = 0.001), fibrinogen <3.3 g/L (AUC = 0.728, OR = 9.9, p = 0.004), and D-dimer > 3,863 ng/mL (AUC = 0.728, OR = 6.7, p = 0.004).Conclusions: Hypocoagulable tendency using thromboelastometry is associated with the severity of septic shock. Conventional coagulation tests may fail to detect hypercoagulability, which is crucial in determining anticoagulation timing.

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Septic Coagulopathy: Pathophysiology, Diagnosis, and Therapeutic Strategies

Karumai,

Kotani,

Yamamoto

et al. 2024

Curr Infect Dis Rep

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Are thromboelastometric and thromboelastographic parameters associated with mortality in septic patients? A systematic review and meta-analysis

Cited by 13 publications

References 46 publications

Study of the Significance of Thromboelastography Changes in Patients with Dyslipidemia

Study of the Significance of Thromboelastography Changes in Patients with Dyslipidemia

Hypocoagulable Tendency on Thromboelastometry Associated With Severity and Anticoagulation Timing in Pediatric Septic Shock: A Prospective Observational Study

Septic Coagulopathy: Pathophysiology, Diagnosis, and Therapeutic Strategies

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