Uncovering Hypercoagulability in Sepsis Using ROTEM

This case series presents three patients with sepsis/septic shock in whom standard coagulation tests (international normalized ratio, activated partial thromboplastin time, fibrinogen, antithrombin, thrombocytes) and ROTEM ® thromboelastometry (InTEM, ExTEM, FibTEM) were simultaneously performed. Although all patients showed significantly prolonged plasmatic coagulation times with a putatively increased risk of bleeding, ROTEM ® thromboelastometry revealed normal clotting times and even signs of hypercoagulability. Therefore, no coagulation active therapy was performed in any patient, not even before invasive procedures or major surgical interventions. No bleeding occurred in any study patient during surgery or the subsequent stay on the intensive care unit. These observations suggest that some critically ill patients with sepsis and abnormal standard coagulation tests may in fact have hypercoagulability. ROTEM ® thromboelastometry can add important information in these patients and enable that blood products are used targeted and only for substitution of relevant deficencies. Future studies are necessary to validate these preliminary findings.