Clinical Study of Low Molecular Weight Heparin in the Treatment of Sepsis-Associated Coagulopathy Based on Thrombelastogram Guidance
Objective:To investigate the efficacy and safety of thrombelastogram(TEG)guidance low molecular weight heparin in the treatment of sepsis-associated coagulopathy(SIC),and the relationship between TEG and prognosis.Methods:185 SIC patients admitted to the Wuming Hospital Affiliated to Guangxi Medical University,The First Affiliated Hospital of Guangxi Medical University and Hezhou Guangji Hospital from January 2021 to June 2023 were selected.The clinical data of SIC patients were collected,and patients were divided into anticoagulant group and non-anticoagulant group according to whether they were anticoagulant.The anticoag-ulation group was divided into hypercoagulable group and normal coagulation group according to the R value of TEG.The clinical in-dexes in three groups after treatment were compared.After 28 days of follow-up,the patients were divided into death group and survival group according to the prognosis.The clinical indexes and coagulation indexes in death group and survival group were compared.The predictive value of death within 28 days in sepsis SIC patients was analyzed by receiver operating characteristic(ROC)curve.Results:The mortality rate within 28 days in hypercoagulable group and normal coagulation group was lower than that in non-anticoagulant group(P＜0.05).The incidence of disseminated intravascular coagulation(DIC)in hypercoagulable group and normal coagulation group was lower than that in non-anticoagulation group(P＜0.05).The proportion of mechanical ventilation,blood purification,septic shock,DIC and multiple organ dysfunction syndrome(MODS)in survival group was lower than that in death group(P＜0.05).The proportion of low molecular weight heparin anticoagulation and the time of low molecular weight heparin anticoagulation in survival group were higher than those in death group(P＜0.05).The sequential organ failure assessment(SOFA)score and acute physiology and chronic health evalu-ation(APACHE Ⅱ)score in death group were higher than those in survival group,and the intensive care unit(ICU)hospitalization time was longer than that in survival group(P＜0.05).The K value,maximum amplitude(MA),comprehensive coagulation index(CI),pro-thrombin time(PT),activated partial thromboplastin time(APTT),prothrombin time-international normalized ratio(PT-INR)and fibrino-gen(FIB)were compared between survival group and death group,the difference was statistically significant(P＜0.05).The results of ROC analysis showed that,the area under the curve(AUC)of K value,APACHE Ⅱ score and SOFA score in predicting 28 d death of SIC patients was 0.653,0.727 and 0.730 respectively,the AUC predicted by combined detection was 0.813,which was higher than that of each index alone.Conclusion:Base on TEG guidance can help to identify the coagulation status of SIC patients and guide the clinical anticoagulation therapy.And TEG(K value)combine with APACHE Ⅱ score and SOFA score has a high predictive value for 28 d death in SIC patients.
SepsisSepsis-associated coagulopathyThrombelastogramLow molecular weight heparinPredictive value
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