Detecting hypercoagulability in sepsis: thromboelastometry vs thrombomodulin-modified thrombin generation test

Introduction Overt disseminated intravascular coagulation (DIC) develops in half of the septic patients by the fifth day, leading to double mortality in sepsis. Hypercoagulability, inevitably present before depletion of clotting factors and platelets, is hardly detected by available screening tests [1,2]. This, in turn, prevents the development of targeted therapy at early stages of DIC. Global coagulation tests, such as the thromboelastography (TEG), thromboelastometry (TEM), thrombin generation (TG) are widely used to diagnose of a prothrombotic state. Thrombomodulin (TM)-modified TG also allows assessment of anticoagulant effect of the protein C (PC) pathway, but technical complexity limits it’s use as a point of care (POC) test. At the same time, hypercoagulability in sepsis is often revealed by TEG or TEM, but the predictive value of these results remains uncertain [3].