Global tests of haemostasis in critically ill patients with severe sepsis syndrome compared to controls.
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.
Collins
Peter W
PW
Department of Haematology, School of Medicine, Cardiff University and University Hospital of Wales, Cardiff, UK. peter.collins@cardffandvale.wales.nhs.uk
Macchiavello
Luis I
LI
Lewis
Sarah J
SJ
Macartney
Nichola J
NJ
Saayman
Anton G
AG
Luddington
Roger
R
Baglin
Trevor
T
Findlay
George P
GP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001779:Blood Coagulation Factors / Q000378:metabolism; D001780:Blood Coagulation Tests / Q000379:methods; D002097:C-Reactive Protein / Q000378:metabolism; D006487:Hemostasis; D006801:Humans; D008875:Middle Aged; D011486:Protein C / Q000378:metabolism; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood*; D013916:Thrombelastography / Q000379:methods; D013917:Thrombin / Q000096:biosynthesis; D013925:Thromboplastin / Q000378:metabolism
D001779:Blood Coagulation Factors; D011486:Protein C; D002097:C-Reactive Protein; D013925:Thromboplastin; D013917:Thrombin