A novel thromboelastographic score to identify overt disseminated intravascular coagulation resulting in a hypocoagulable state

Abstract

Thromboelastography (TEM) yields a multitude of data that are complicated to analyze. We evaluated its value in identification of global coagulopathy in overt disseminated intravascular coagulation (DIC). We studied 21 patients, each with International Society for Haemostasis and Thrombosis scores of 5 or more (compatible with overt DIC) and less than 5 (suggestive of nonovert DIC), who underwent whole blood nonadditive TEM. A TEM score based on the reaction and kappa times, alpha angle, and maximum amplitude was defined as the total number of TEM parameters deranged in the direction of hypocoagulability. The TEM score at a cutoff of 2 or more achieved sensitivity of 95.2%, specificity of 81.0%, and the highest receiver operating characteristic area under the curve of all parameters of 0.957 for identifying overt DIC. Individual TEM parameters correlated variably with conventional tests. Their combination into a cohesive TEM score possibly better captured the multiple hemostatic derangements occurring in DIC. The TEM score may bring objectivity to the analysis of TEM data.