Thrombelastography and sepsis 英文参考文献.docVIP

Available online /content/11/2/409 Letter Thrombelastography and sepsis Rudolph Puana and Joseph L Nates Department of Critical Care, Division of Anesthesiology and Critical Care, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA Corresponding author: Joseph L Nates, jlnates@ Published: 19 April 2007 Critical Care 2007, 11:409 (doi:10.1186/cc5712) This article is online at /content/11/2/409 ? 2007 BioMed Central Ltd We read with great interest the recent report by Gonano et al. [1] describing the effects of antithrombin versus placebo in the coagulation profile of a group of patients with severe sepsis. However, we thought that several important issues needed to be addressed in regards to hypercoagulability and thrombelastography (TEG). First, hypercoagulability was not clearly defined in the study. Second, neither Coagulation Index (CI) nor Thrombodynamic Potential Index (an alternative TEG index of hypercoagulability) [2] were calculated or reported. Third, conventional studies of hypercoagulability were not performed in parallel. Fourth, Table 2 in the paper shows that some patients had low fibrinogen, platelets, and prolonged A decade ago, Grant and Hadley [3] described the coagula- tion changes of 27 neonates with sepsis and found a ‘hypo- coagulability’ profile in 85% of the neonates studied. These findings are also supported in animal data for which our lab has shown similar hypocoagulable patterns in a porcine model of sepsis using TEG [4]. Hypercoagulability is defined in thromboelastography as a CI greater than +3 [2]. This means that patients with reaction time (r), coagulation time (k), alpha angle, or maximum amplitude on the ‘hypercoagulable side’ may still fall within a normal CI range and not meet criteria to be called activated ‘hypocoagulable’ thrombelastogram (CI lower than