IngentaConnect Global tests of haemostasis in critically ill patients with sever...

Authors: Collins, Peter W.¹; Macchiavello, Luis I.²; Lewis, Sarah J.¹; Macartney, Nichola J.¹; Saayman, Anton G.²; Luddington, Roger³; Baglin, Trevor³; Findlay, George P.²

Source: British Journal of Haematology, Volume 135, Number 2, October 2006 , pp. 220-227(8)

Publisher: Blackwell Publishing

Abstract:

Summary

Haemostatic changes in septic patients are complex, with both procoagulant and anticoagulant changes. Thirty-eight patients with severe sepsis and 32 controls were investigated by coagulation screens, individual factor assays, calibrated automated thrombography (CAT), whole blood low-dose-tissue factor activated (LD-TFA) Rotem and LD-TFA waveform analysis. Thirty-six of 38 patients had an abnormal coagulation screen. The mean levels of factors II, V (P < 0·05), VII, X, XI and XII, antithrombin and protein C (P < 0·01) was decreased in sepsis compared with controls. The mean factor VIII and fibrinogen level (P < 0·001) was increased. CAT in platelet rich and poor plasma showed a prolonged lag time (P < 0·02), decreased peak thrombin (P < 0·02) and delayed time to peak thrombin (P < 0·001) in sepsis patients, however, the endogenous thrombin potential was equivalent in sepsis and controls. In LD-TFA Rotem, septic patients had delayed clot times (P = 0·04) but an increased maximum velocity of clot formation (P < 0·01) and area under the clot elasticity curve (P < 0·01). LD-TFA waveform analysis showed a delayed onset time but an increased rate of clot formation (P < 0·005). In conclusion, global tests of haemostasis suggest that in this patient group, activation of haemostasis is delayed but once initiated thrombin generation and clot formation are normal or enhanced.

Keywords: global haemostasis; sepsis; thrombin generation; thromboelastography; thrombosis

Document Type: Research article

DOI: 10.1111/j.1365-2141.2006.06281.x

Affiliations: 1: Department of Haematology, School of Medicine, Cardiff University and University Hospital of Wales, Cardiff 2: Department of Intensive Care Medicine, Cardiff University and University Hospital of Wales, Cardiff 3: Department of Haematology, Addenbrookes Hospital, Cambridge, UK

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Global tests of haemostasis in critically ill patients with severe sepsis syndrome compared to controls