rotational ThROmboelastometry in Patients at risk for disseminated Intravascular Coagulation*

Disseminated intravascular coagulation (DIC) is a devastating complication of
critical illness and an independent predictor of organ failure and mortality.
Thereby, patients are at risk for both bleeding and thromboembolic events.
Current diagnostics do not predict the risk for thrombosis or bleeding and
hence cannot discriminate which patients would benefit or harm from an
anticoagulant strategy.

Rotational thromboelastometry (ROTEM) can both detect a hypo- and
hypercoagulable profile and therefore may have the potential to diagnose both
DIC as well as predict risks of bleeding an thrombosis in patients at risk for
DIC. Besides the limited knowledge on individual risk factors for bleeding or
thrombosis, the exact pathophysiology of DIC also remains unknown. Experimental
data suggest that fibrinogen may protect against DIC by binding histones, but
clinical data are scarce.

The aim of this study is twofold: 1) to measure ROTEM profiles in patients at
risk for DIC to determine cut off values of ROTEM corresponding to the
currently used International Society for Thrombosis and Haemostasis (ISTH) DIC
scores, as well as to bleeding and thromboembolic events. 2) to measure
histones and other parameters of the DIC coagulation cascade to improve insight
in the pathophysiology

Multi center observational cohort study

The burden and risk associated with participation are negligible. A single
blood sample will be obtained from the arterial line whichis already in place