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The Utility of Thromboelastometry (ROTEM) or Thromboelastography (TEG) in Non-bleeding ICU Patients

  • Chapter
Annual Update in Intensive Care and Emergency Medicine 2014

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM,volume 2014))

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Abstract

A hypocoagulable state is highly prevalent in critically ill patients. An international normalized ratio (INR) of > 1.5 occurs in 30 % of patients and is associated with increased mortality [1]. Moreover, up to 40 % of critically ill patients develop thrombocytopenia during their intensive care unit (ICU) stay [2–4], associated with increased length of stay, need for transfusion of blood products and increased mortality [5]. Disseminated intravascular coagulation (DIC) develops in 10 to 20 % of ICU patients. A hypercoagulable state is associated with increased thromboembolic events [6], contributes to organ failure and is associated with a high mortality, ranging from 45 to 78 % [7].

Coagulopathy is thought to result from an imbalance between activation of coagulation and impaired inhibition of coagulation and fibrinolysis. Activation is triggered by tissue factor, which is expressed in reaction to cytokines or endothelial damage. Impaired inhibition of coagulation is the consequence of reduced plasma levels of antithrombin (AT), depressed activity of the protein C system and decreased levels of tissue factor pathway inhibitor (TFPI). A decrease in fibrinolysis is due to increased levels of plasminogen activator inhibitor type 1 (PAI-1) [8, 9]. This disturbance between components of the coagulation system leads to a variable clinical picture, ranging from patients with an increased bleeding tendency (hypocoagulable state) to those with DIC with (micro-) vascular thrombosis (hypercoagulable state).

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Authors and Affiliations

  1. Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands

    K. Balvers, M.C. Muller & N.P. Juffermans

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  1. K. Balvers
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  2. M.C. Muller
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  3. N.P. Juffermans
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Correspondence to N.P. Juffermans .

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  1. Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent Prof.

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Balvers, K., Muller, M., Juffermans, N. (2014). The Utility of Thromboelastometry (ROTEM) or Thromboelastography (TEG) in Non-bleeding ICU Patients. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2014. Annual Update in Intensive Care and Emergency Medicine, vol 2014. Springer, Cham. https://doi.org/10.1007/978-3-319-03746-2_43

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  • DOI: https://doi.org/10.1007/978-3-319-03746-2_43

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-03745-5

  • Online ISBN: 978-3-319-03746-2

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