Thrombelastography and sepsis

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 activated partial thromboplastin time with a probably ‘hypocoagulable’ thrombelastogram (CI lower than -3) profile.