Utility of thromboelastography and/or thromboelastometry in adults with sepsis: a systematic review.
Crit Care. 2014 Feb 10;18(1):R30
Authors: Müller MC, Meijers JC, Vroom MB, Juffermans NP
INTRODUCTION: Coagulation abnormalities are frequent in sepsis. Conventional coagulation assays however, have several limitations. There is a surge of interest in the use of point of care tests to diagnose hypo- and hypercoagulability in sepsis. We performed a systematic review of available literature to establish the value of rotational thromboelastography (TEG(R)) and thromboelastometry (ROTEM(R)) compared to standard coagulation tests to detect hyper- or hypocoagulability in sepsis patients. Furthermore the value of TEG(R)/ROTEM(R) to identify sepsis patients likely to benefit from therapies that interfere with the coagulation system was assessed.
METHODS: MEDLINE, EMBASE, and the Cochrane Library were searched from 1 January 1980 to 31 December 2012. The search was limited to adults and language was limited to English. Reference lists of retrieved papers were hand-searched for additional studies. Ongoing trials were searched on www.controlled-trials.com and www.clinicaltrials.gov. Studies addressing TEG(R)/ROTEM(R) measurements in adult patients with sepsis admitted to the ICU were considered eligible.
RESULTS: Of 680 screened articles, 18 studies were included, of which 2 were randomized controlled trials and 16 were observational cohort studies. In patients with sepsis, results show both hyper- and hypocoagulability, as well as TEG(R)/ROTEM(R) values which fell within reference values. Both hyper- and hypocoagulability were to some extent associated with diffuse intravascular coagulation. Compared to conventional coagulation tests, TEG(R)/ROTEM(R) can detect impaired fibrinolysis, which can possibly help to discriminate between sepsis and systemic inflammatory response syndrome (SIRS). A hypocoagulable profile is associated with increased mortality. The value of TEG(R)/ROTEM(R) to identify patients with sepsis who could possibly benefit from therapies interfering with the coagulation system could not be assessed, since studies addressing this topic were limited.
CONCLUSION: TEG(R)/ROTEM(R) could be a promising tool in diagnosing alterations in coagulation in sepsis. Further research on the value of TEG(R)/ROTEM(R) in these patients is warranted. Given that coagulopathy is a dynamic process, sequential measurements are needed to understand the coagulation patterns in sepsis as can be detected by TEG(R)/ROTEM(R).
PMID: 24512650 [PubMed - as supplied by publisher]