Role of thromboelastography in septic patients treated with coagulation inhibitor

Introduction

Substitutive treatment with coagulation natural inhibitors could be associated with severe bleedings in surgical patients. We evaluate the role of thromboelastography (TEG) in monitoring of septic patients during treatment with AT III and aPC.

Methods

We enrolled all the patients admitted in ICU for more 48 hours with surgical severe sepsis associated with severe deficiency of coagulation natural inhibitors. Two groups were created. Group A treated with activated PC 24 μg/kg for 96 hours and Group B with, in addition, AT III administered by the target [(140 - AT III dosed) × BW (kg)]. TEG was registered before, at the beginning, during the treatment every 12 hours and 24 hours after the end of administration. We also registered the SOFA score until discharge.

Results

The clinical data and results are presented in Tables 1 and 2.

Table 1 (abstract P345)

Table 2 (abstract P345)

Conclusions

TEG allows, at the bedside, the dynamic monitoring of coagulation systems. APC has an anticoagulant and profibrinolitic role without haemorrhagic effects and this is registered by TEG. It is interesting to notice that the use of AT III and aPC in the septic patients has no haemorrhagic effects and this is also confirmed by SOFA and by our preliminary data about 28-day mortality. We believe that the TEG could solve a lot of problems related to the correct timing of sepsis and to inhibitor treatment.