Thromboelastography in patients with severe sepsis: a prospective cohort study.

Over the last decade, viscoelastic tests have been increasingly used in different clinical conditions associated with a high bleeding risk. Both thromboelastography (TEG) and rotational thromboelastometry (ROTEM) have been used successfully to monitor coagulopathy and guide haemostatic therapies in bleeding patients.

With the exception of trauma patients, these tests have been little studied in critically ill patients, especially in the context of medical illness such as sepsis or septic shock. In this sub-analysis of the 6S trial, which compared 6% hydroxyethyl starch (HES) and Ringer’s acetate for fluid resuscitation in sepsis, the authors assessed the relationship between daily TEG results and outcome in patients with severe sepsis. Interestingly, the authors observed a significant correlation between the progressive coagulopathy observed on the TEG, the bleeding risk and mortality.

Although the results should be interpreted with caution due to huge number of potential unmeasured confounding variables that were included in this retrospective post-hoc analysis, this study describes in a large population of septic patients the usefulness of TEG for the diagnosis and the management of sepsis-induced coagulopathy.

– David Faraoni

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