Thromboelastometric evaluation of sepsis associated coagulopathy: A cohort study

Saraiva, Ivan Euclides Borges; Miranda, Paula K.; Freitas, Jaqueline N.; Oliveira, Clara Rodrigues Alves de; Ataíde, Thiago L.B.S.; Nobre, Vandack; Andrade, Marcus V.

doi:10.1016/j.thromres.2016.10.003

Cited by 8 publications

(8 citation statements)

References 10 publications

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“…In this study, we tested the hypothesis that TLRs play a pivotal role in host procoagulant responses and contribute to SIC. Using rotational thromboelastometry (ROTEM), we examined the role of various types of TLR signaling in SIC, explored the underlying mechanisms, and tested the effect of TLR activation on procoagulant expression in immune cells.…”

Section: Introductionmentioning

confidence: 99%

Toll‐like receptors 2 and 7 mediate coagulation activation and coagulopathy in murine sepsis

Williams

Neder

Cui

et al. 2019

Journal of Thrombosis and Haemostasis

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Background Sepsis is a life‐threatening condition often manifested as marked inflammation and severe coagulopathy. Toll‐like receptors (TLRs) play a pivotal role in inflammation, organ dysfunction and mortality in animal sepsis. Objectives To investigate the role of TLR signaling in mediating sepsis‐induced coagulopathy (SIC) in a mouse model. Methods Polymicrobial sepsis was created by cecal ligation and puncture (CLP) or fecal slurry peritoneal injection. To quantify global clotting function, two viscoelastic assays were performed with rotational thromboelastometry, and the results were presented as maximum clot firmness (MCF): (a) EXTEM to test tissue factor (TF)‐initiated clot formation; and (b) FIBTEM to test EXTEM in the presence of a platelet inhibitor, cytochalasin D. Plasma coagulation factors were quantified with ELISA. TF gene expression and protein expression were determined with real‐time quantitative reverse transcription PCR and flow cytometry, respectively. Results Between 4 and 24 hours after CLP surgery, wild‐type mice showed significant MCF reduction in both EXTEM and FIBTEM tests. This was accompanied by marked thrombocytopenia and a significant increase in the levels of plasminogen activator inhibitor‐1, plasma TF, and D‐dimer. In comparison, TLR2−/− and TLR7−/− CLP mice showed preserved MCF and platelet counts, and near‐normal plasma TF levels. Bone marrow–derived macrophages treated with a TLR2 agonist Pam3cys‐Ser‐(Lys)4 (Pam3cys) or a TLR7 agonist (R837) showed marked increases in TF gene expression and protein expression. MicroRNA‐146a, a newly identified proinflammatory mediator that is upregulated during sepsis, induced TF production via a TLR7‐dependent mechanism. Conclusions Murine sepsis leads to an increased procoagulant response, thrombocytopenia, and global coagulopathy. TLR2 and TLR7 play an important role in procoagulant production and in SIC.

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Section: Introductionmentioning

confidence: 99%

Toll‐like receptors 2 and 7 mediate coagulation activation and coagulopathy in murine sepsis

Williams

Neder

Cui

et al. 2019

Journal of Thrombosis and Haemostasis

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“…TEG is measuring all coagulation proteins and cellular elements on clot formation; it can trace the whole coagulation process from the beginning of coagulation to the lysis of blood clots and show the whole process in a form of a graph [17]. TEG has been widely applied in monitoring hemostasis during cardiac surgery and liver transplant procedures [21], guiding transfusion requirements in trauma patients, and during surgery and assessing septic coagulopathy in severely ill patients [15]. TEG can provide comprehensive coagulation status of our body, and provides additional data compared with standard coagulation tests [21].…”

Section: Discussionmentioning

confidence: 99%

“…Some biomarkers, such as D-Dimer and brinogen (Fib) have been proved promising in PJI diagnosis [10][11][12][13] and determining the timing of reimplantation [10,14]. Thromboelastography (TEG) is a routine test of coagulation that assesses the whole process of the clotting along time in the body [15], TEG provides a full-scale evaluation of clot formation, elasticity, and duration with measures describing various coagulation elements [16]. K-value (clotting time) re ects the rate of blood clot formation and is an indicator of brinogen function [17], Angle (α-angle) represents the clot growth rate, MA (maximum amplitude) means the maximum clot amplitude [18], A30 (amplitude at 30 min) measures clot strength at 30 minutes after MA [19], and TPI (thrombodynamic potential index) was derived from MA and K value [20].…”

Section: Introductionmentioning

confidence: 99%

“…Plentiful literature has proved that TEG is useful in evaluating coagulation status, predicting bleeding in patients with severe sepsis, monitoring hemostasis during cardiac surgery and liver transplant procedures, etc. [15,21,22]. However, no study has reported its value in diagnosing PJI and guiding reimplantation timing for the second-stage revision before.…”

Section: Introductionmentioning

confidence: 99%

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Thromboelastography Performs Well for the Diagnosis of Periprosthetic Joint Infection.

Yuan

Wang

2021

Preprint

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Background: Coagulation-related biomarkers are drawing new attention in diagnosing periprosthetic joint infection (PJI). Thromboelastography (TEG) analysis provides a comprehensive assessment of coagulation and therefore could be a promising test for PJI. This study aims to assess the value of TEG in diagnosing PJI and to determine the clinical significance of TEG in analyzing reimplantation timing for the second-stage revision.Methods: From October 2017 to September 2020, 62 patients who underwent revision arthroplasty were prospectively included, PJI was defined by 2011 Musculoskeletal Infection Society (MSIS) criteria. Twenty-three patients were diagnosed with PJI (Group A) and the other 39 patients were included as aseptic loosen (Group B). Seventeen patients in Group A finished two-stage revision in our center. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), D-dimer and TEG parameters (K (clotting time), Angle (α-angle), MA (maximum amplitude), A30 (amplitude at 30 min), TPI (thrombodynamic potential index)) were measured preoperatively in all included patients. Receiver operating characteristic curves were applied to evaluate the diagnostic value of these biomarkers.Results: ESR (AUC 0.953, sensitivity 81.82, specificity 94.87) performed best in PJI diagnosis, followed by MA (AUC 0.895, sensitivity 82.61, specificity 97.44) and CRP (AUC 0.893, sensitivity 82.61, specificity 94.74). When these biomarkers combined in pairs, the diagnosis value improved compared with any individual biomarker. The overall success rate of the two-stage revision was 100%. ESR and MA showed valuable in determining the time of reimplantation, with their values all decreased below cut-off values before reimplantation.Conclusion: TEG could be a promising test in assisting PJI diagnosis, and a useful tool in judging the proper timing of reimplantation.

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“…[4][5][6] Coagulation defects may also be inherited, occurring due to abnormal levels of natural procoagulant and anticoagulant factors, or can accompany illnesses such as liver disease, malignancies, and septicemia. [7][8][9] Depending on the type of coagulation defect, bleeding disorders are reversed by transfusing allogenic blood products. Currently, the identification of coagulation defects and the associated bleeding risk is based on conventional coagulation testing (CCT), mainly, prothrombin and activated partial thromboplastin time (aPTT), clotting factors, platelet counts, and other indices that take several hours before results are obtained.…”

Section: Introductionmentioning

confidence: 99%

Comprehensive Blood Coagulation Profiling in Patients Using iCoagLab: Comparison Against Thromboelastography

et al. 2020

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AbstractDelayed identification of coagulopathy and bleeding increases the risk of organ failure and death in hospitalized patients. Timely and accurate identification of impaired coagulation at the point-of-care can proactively identify bleeding risk and guide resuscitation, resulting in improved outcomes for patients. We test the accuracy of a novel optical coagulation sensing approach, termed iCoagLab, for comprehensive whole blood coagulation profiling and investigate its diagnostic accuracy in identifying patients at elevated bleeding risk. Whole blood samples from patients (N = 270) undergoing conventional coagulation testing were measured using the iCoagLab device. Recalcified and kaolin-activated blood samples were loaded in disposable cartridges and time-varying intensity fluctuation of laser speckle patterns were measured to quantify the clot viscoelastic modulus during coagulation. Coagulation parameters including the reaction time (R), clot progression time (K), clot progression rate (α), and maximum clot strength (MA) were derived from clot viscoelasticity traces and compared with mechanical thromboelastography (TEG). In all patients, a good correlation between iCoagLab- and TEG-derived parameters was observed (p < 0.001). Multivariate analysis showed that iCoagLab-derived parameters identified bleeding risk with sensitivity (94%) identical to, and diagnostic accuracy (89%) higher than TEG (87%). The diagnostic specificity of iCoagLab (77%) was significantly higher than TEG (69%). By rapidly and comprehensively permitting blood coagulation profiling the iCoagLab innovation is likely to advance the capability to identify patients with elevated risk for bleeding, with the ultimate goal of preventing life-threatening hemorrhage.

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Thromboelastometric evaluation of sepsis associated coagulopathy: A cohort study

Cited by 8 publications

References 10 publications

Toll‐like receptors 2 and 7 mediate coagulation activation and coagulopathy in murine sepsis

Toll‐like receptors 2 and 7 mediate coagulation activation and coagulopathy in murine sepsis

Thromboelastography Performs Well for the Diagnosis of Periprosthetic Joint Infection.

Comprehensive Blood Coagulation Profiling in Patients Using iCoagLab: Comparison Against Thromboelastography

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