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    Poster Networking

    Coagulation and Natural Anticoagulants

    Poster Networking Session

    PB1038 - Differences in clot formation and lysis between septic patients and controls assessed by whole-blood thromboelastometry: a prospective observational study

    Tuesday, June 27, 2023
    18:30 – 19:30 ET
    Room: Exhibition

      Presenting Author(s)

    • Ecaterina Scarlatescu, MD PhD MSc

      Assistant Professor, Consultant in Anesthesia and Intensive Care Medicine
      University of Medicine and Pharmacy "Carol Davila"
      Bucharest, Bucuresti, Romania

      • Co-Author(s)

    • Paul Y. Kim, PhD (he/him/his)

      Associate Professor
      Department of Medicine, McMaster University
      Hamilton, Ontario, Canada

    • SM

      Sergey P. Marchenko

      Professor
      Department of Cardiac Surgery, Pavlov First St. Petersburg Medical University, St. Petersburg, Russian Federation
      Saint Petersburg, Saint Petersburg City, Russia

    • DT

      Dana R. Tomescu

      Professor
      University of Medicine and Pharmacy "Carol Davila" Bucharest Romania
      Bucharest, Bucuresti, Romania

    Background: Sepsis is associated with the dysregulation of procoagulant, anticoagulant, and fibrinolytic pathways. Whole-blood viscoelastic tests assess the overall clot formation and lysis, which can better reflect the changes to the hemostatic properties than standard coagulation tests (SCTs).

    Aims: To compare the measurements of coagulation activation, clot formation, stabilization, and lysis between rotational thromboelastometry (ROTEM) and SCTs on septic patients (SP) and healthy controls (HC).

    Methods: After approval of the institutional ethics committee, 30 SP (according to Sepsis-3 definition) and 30 HC were included in this observational study. SCTs and ROTEM analyses were conducted at study inclusion with lysis being initiated by the addition of tPA (0, 175, or 300 ng/ml). The study received funding from ISTH (SSC Grant).

    Results: Prothrombin time and fibrinogen were higher and platelet counts were lower in SP compared to HC. Clotting initiation was prolonged in activated samples (EXTEM, FIBTEM) and similar in non-activated (NATEM) SP samples when compared with HC. Maximum velocity of clot formation (MAXV) was higher in SP compared to HC. Clot firmness and elasticity were higher for SP in the absence of tPA; with tPA addition, however, clot firmness was similar in SP and HC. Maximum clot elasticity and platelet component were increased in SP compared with HC in all samples except those with the highest tPA concentration. Clot lysis indices (CLI) were similar in FIBTEM, while SP displayed higher CLI using EXTEM and APTEM compared with HC. ΔCLI (APTEM minus EXTEM) was lower for both native and tPA-spiked samples in SP compared with HC.

    Conclusion(s): SP have delayed coagulation initiation, but increased coagulation propagation, clot firmness, and clot elasticity, and higher platelet contribution despite having lower platelet counts compared with HC. Both clot retraction and lysis (with or without tPA) are decreased in SP compared with HC.