{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T01:48:41Z","timestamp":1792460921542,"version":"4.5.0"},"reference-count":44,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Sepsis-induced coagulopathy (SIC) represents an early, predominantly prothrombotic disturbance that is difficult to detect using conventional coagulation tests. This review aims to evaluate whether rotational thromboelastometry (ROTEM) provides added value in the diagnosis and phenotyping of SIC compared with standard laboratory parameters. We summarize current evidence on SIC pathophysiology and its relationship to disseminated intravascular coagulation (DIC), with particular focus on mechanisms driving hypercoagulability and fibrinolytic shutdown. The limitations of routine tests, platelet count, PT\/INR, fibrinogen, and fibrin-related markers are examined, especially their inability to capture early dynamic changes in coagulation. We then outline the principles of ROTEM and review clinical studies assessing its application in sepsis. Available data consistently demonstrate increased clot firmness, frequently driven by elevated fibrinogen, along with impaired fibrinolysis. These patterns often precede overt SIC or DIC and are associated with worse clinical outcomes, including organ dysfunction and mortality. Finally, we discuss the implications of these findings for clinical management. While routine anticoagulation in unselected septic patients remains unsupported, integrating SIC criteria with ROTEM profiles may improve risk stratification and help identify prothrombotic phenotypes that could benefit from targeted therapies. Overall, ROTEM appears to be a valuable adjunct to conventional testing, with potential to refine diagnostic accuracy and guide future interventional strategies in septic coagulopathy.<\/jats:p>","DOI":"10.3390\/medsci14030385","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:55:32Z","timestamp":1783598132000},"page":"385","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Role of Thromboelastometry in Sepsis-Induced Coagulopathy: A Narrative Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4344-9978","authenticated-orcid":false,"given":"Andrzej","family":"Lubiewski","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8219-2912","authenticated-orcid":false,"given":"Mariusz","family":"Siemi\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1001\/jama.2016.0288","article-title":"Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Seymour","year":"2016","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Tsantes, A.G., Parastatidou, S., Tsantes, E.A., Bonova, E., Tsante, K.A., Mantzios, P.G., Vaiopoulos, A.G., Tsalas, S., Konstantinidi, A., and Houhoula, D. (2023). Sepsis-Induced Coagulopathy: An Update on Pathophysiology, Biomarkers, and Current Guidelines. Life, 13.","DOI":"10.3390\/life13020350"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1213\/ANE.0000000000006888","article-title":"Sepsis-Induced Coagulopathy: A Comprehensive Narrative Review of Pathophysiology, Clinical Presentation, Diagnosis, and Management Strategies","volume":"138","author":"Williams","year":"2024","journal-title":"Anesth. Analg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1111\/jth.14578","article-title":"Diagnosis and management of sepsis-induced coagulopathy and disseminated intravascular coagulation","volume":"17","author":"Iba","year":"2019","journal-title":"J. Thromb. Haemost."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"089","DOI":"10.1055\/s-0039-1694995","article-title":"Sepsis-Induced Coagulopathy and Disseminated Intravascular Coagulation","volume":"46","author":"Iba","year":"2020","journal-title":"Semin Thromb. Hemost."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1186\/s13613-024-01380-5","article-title":"Sepsis-induced coagulopathy (SIC) in the management of sepsis","volume":"14","author":"Iba","year":"2024","journal-title":"Ann. Intensive Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s13613-022-01093-7","article-title":"The prevalence of sepsis-induced coagulopathy in patients with sepsis\u2014A secondary analysis of two German multicenter randomized controlled trials","volume":"13","author":"Schmoch","year":"2023","journal-title":"Ann. Intensive Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e017046","DOI":"10.1136\/bmjopen-2017-017046","article-title":"New criteria for sepsis-induced coagulopathy (SIC) following the revised sepsis definition: A retrospective analysis of a nationwide survey","volume":"7","author":"Iba","year":"2017","journal-title":"BMJ Open"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Drotarova, M., Zolkova, J., Belakova, K.M., Brunclikova, M., Skornova, I., Stasko, J., Stasko, J., and Simurda, T. (2023). Basic Principles of Rotational Thromboelastometry (ROTEM\u00ae) and the Role of ROTEM-Guided Fibrinogen Replacement Therapy in the Management of Coagulopathies. Diagnostics, 13.","DOI":"10.3390\/diagnostics13203219"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"100031","DOI":"10.1016\/j.rpth.2022.100031","article-title":"Viscoelastic testing: An illustrated review of technology and clinical applications","volume":"7","author":"Hartmann","year":"2023","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Schmoch, T., M\u00f6hnle, P., Nusshag, C., Feisst, M., Weigand, M.A., and Brenner, T. (2025). Impending sepsis-induced coagulopathy (SIC) is associated with increased disease severity in SIC-negative patients: A secondary analysis of a prospective exploratory study. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1525538"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s13613-019-0499-6","article-title":"Acute fibrinolysis shutdown occurs early in septic shock and is associated with increased morbidity and mortality: Results of an observational pilot study","volume":"9","author":"Schmitt","year":"2019","journal-title":"Ann. Intensive Care"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Czempik, P.F., and Wi\u00f3rek, A. (2024). Rotational Thromboelastometric Profile in Early Sepsis: A Prospective Cohort Study. Biomedicines, 12.","DOI":"10.3390\/biomedicines12081880"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.jtha.2022.10.022","article-title":"Communication from the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis on sepsis-induced coagulopathy in the management of sepsis","volume":"21","author":"Iba","year":"2023","journal-title":"J. Thromb. Haemost."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Jarczak, D., Kluge, S., and Nierhaus, A. (2021). Sepsis\u2014Pathophysiology and Therapeutic Concepts. Front. Med., 8.","DOI":"10.3389\/fmed.2021.628302"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2450","DOI":"10.1016\/j.immuni.2021.10.012","article-title":"The immunology of sepsis","volume":"54","author":"Wiersinga","year":"2021","journal-title":"Immunity"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/SHK.0000000000000473","article-title":"The Endothelium in Sepsis","volume":"45","author":"Ince","year":"2016","journal-title":"Shock"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s13054-018-2292-6","article-title":"The glycocalyx: A novel diagnostic and therapeutic target in sepsis","volume":"23","author":"Uchimido","year":"2019","journal-title":"Crit. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1164\/rccm.201910-1911TR","article-title":"Endothelial Responses in Sepsis","volume":"202","author":"Joffre","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1161\/CIRCRESAHA.117.310795","article-title":"Circulating Platelets as Mediators of Immunity, Inflammation, and Thrombosis","volume":"122","author":"Koupenova","year":"2018","journal-title":"Circ. Res."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Assinger, A., Schrottmaier, W.C., Salzmann, M., and Rayes, J. (2019). Platelets in Sepsis: An Update on Experimental Models and Clinical Data. Front. Immunol., 10.","DOI":"10.3389\/fimmu.2019.01687"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1724","DOI":"10.1161\/ATVBAHA.119.312463","article-title":"Neutrophil Extracellular Traps: Villains and Targets in Arterial, Venous, and Cancer-Associated Thrombosis","volume":"39","author":"Hisada","year":"2019","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1038\/s41569-021-00552-1","article-title":"Interplay between inflammation and thrombosis in cardiovascular pathology","volume":"18","author":"Stark","year":"2021","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3062","DOI":"10.1182\/blood-2015-11-680744","article-title":"Thrombocytopenia is associated with a dysregulated host response in critically ill sepsis patients","volume":"127","author":"Claushuis","year":"2016","journal-title":"Blood"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Scarlatescu, F., Scarlatescu, E., Thachil, J., Tomescu, D.R., and Bartos, D. (2025). The Fibrinolytic System in Bacterial Sepsis: A Comprehensive Review of Current Assessment Methods. J. Clin. Med., 14.","DOI":"10.3390\/jcm14176055"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"23","DOI":"10.14789\/jmj.JMJ23-0041-P","article-title":"Endothelial Glycocalyx Protection in Sepsis","volume":"70","author":"Levy","year":"2024","journal-title":"Juntendo Med. J."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Tipoe, T.L., Wu, W.K.K., Chung, L., Gong, M., Dong, M., Liu, T., Roever, L., Ho, J., Wong, M.C.S., and Chan, M.T.V. (2018). Plasminogen Activator Inhibitor 1 for Predicting Sepsis Severity and Mortality Outcomes: A Systematic Review and Meta-Analysis. Front. Immunol., 9.","DOI":"10.3389\/fimmu.2018.01218"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s40560-023-00672-5","article-title":"The pathophysiology, diagnosis, and management of sepsis-associated disseminated intravascular coagulation","volume":"11","author":"Iba","year":"2023","journal-title":"J. Intensive Care"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"28","DOI":"10.4103\/tjem.tjem_36_25","article-title":"Sepsis-induced coagulopathy and its association with mortality in patients with sepsis and septic shock","volume":"26","author":"Quy","year":"2026","journal-title":"Turk. J. Emerg. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"109554","DOI":"10.1016\/j.thromres.2025.109554","article-title":"Thrombosis, bleeding, and mortality in patients with sepsis-induced coagulopathy: Analysis of a prospective cohort","volume":"257","author":"Turcato","year":"2026","journal-title":"Thromb. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"334","DOI":"10.4266\/kjccm.2016.00339","article-title":"The Prevalence and Significance of Overt Disseminated Intravascular Coagulation in Patients with Septic Shock in the Emergency Department According to the Third International Consensus Definition","volume":"31","author":"Ko","year":"2016","journal-title":"Korean J. Crit. Care Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s40560-025-00794-y","article-title":"Disseminated intravascular coagulation","volume":"13","author":"Gando","year":"2025","journal-title":"J. Intensive Care"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"155436","DOI":"10.1016\/j.jcrc.2026.155436","article-title":"The impact of coagulopathy on prognosis in critically ill patients with sepsis: A nationwide cohort study","volume":"93","author":"Ha","year":"2026","journal-title":"J. Crit. Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"109485","DOI":"10.1016\/j.thromres.2025.109485","article-title":"Disseminated intravascular coagulation resolution as a surrogate outcome for mortality in sepsis-associated disseminated intravascular coagulation","volume":"255","author":"Wada","year":"2025","journal-title":"Thromb. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1007\/s12185-024-03896-9","article-title":"Clinical practice guidelines for management of disseminated intravascular coagulation in Japan 2024. Part 1: Sepsis","volume":"121","author":"Yamakawa","year":"2025","journal-title":"Int. J. Hematol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"10760296231195089","DOI":"10.1177\/10760296231195089","article-title":"Potential Biomarkers for Early Diagnosis, Evaluation, and Prognosis of Sepsis-Induced Coagulopathy","volume":"29","author":"Li","year":"2023","journal-title":"Clin. Appl. Thromb."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1002\/ajh.23599","article-title":"TEG and ROTEM: Technology and clinical applications","volume":"89","author":"Whiting","year":"2014","journal-title":"Am. J. Hematol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"102521","DOI":"10.5492\/wjccm.v14.i2.102521","article-title":"Redefining haemostasis: Role of rotational thromboelastometry in critical care settings","volume":"14","author":"Kataria","year":"2025","journal-title":"World J. Crit. Care Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"R42","DOI":"10.1186\/cc7765","article-title":"Thromboelastometry for the assessment of coagulation abnormalities in early and established adult sepsis: A prospective cohort study","volume":"13","author":"Daudel","year":"2009","journal-title":"Crit. Care"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Murao, S., and Yamakawa, K. (2019). A Systematic Summary of Systematic Reviews on Anticoagulant Therapy in Sepsis. J. Clin. Med., 8.","DOI":"10.3390\/jcm8111869"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e884","DOI":"10.1002\/ams2.884","article-title":"Anticoagulant therapies against sepsis-induced disseminated intravascular coagulation","volume":"10","author":"Umemura","year":"2023","journal-title":"Acute Med. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s12959-025-00812-x","article-title":"Efficacy and safety of anticoagulant therapy in patients with sepsis: A meta-analysis of randomized controlled trials","volume":"24","author":"Wang","year":"2025","journal-title":"Thromb. J."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/3\/385\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T12:21:40Z","timestamp":1783599700000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/3\/385"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":44,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["medsci14030385"],"URL":"https:\/\/doi.org\/10.3390\/medsci14030385","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]}}}