Biomarkers and diagnostic tests for coagulopathies in the critically ill and injured

Coagulopathy is a severe complication of both critical illness and injury, contributing to morbidity and mortality. As such, there is a clear clinical need for improved hemostasis management. However, to date, methods of (early) detection of coagulopathy are limited.
Coagulopathy in the critically ill has many phenotypes, ranging from a hyper- to a hypocoagulable state that can give rise to multiple hemostatic complications including thrombosis and bleeding, which can also occur simultaneously. Early clinical suspicion of thrombosis is important to guide timing of imaging tools. Evidently, the assessment of risk of thrombosis and bleeding is important for decisions about timing and dose of anticoagulant therapy. Additionally, a better understanding of the risk of bleeding can help decisions about specific procoagulant interventions.
In the critically injured, coagulopathy also frequently occurs, with an inability to clot during bleeding, which may transition to a hypercoagulable state after bleeding has been contained. Rotational thromboelastometry (ROTEM) is used as a point-of-care test to guide bleeding, but knowledge about the coagulation disturbances that underlie the test results is limited.
In this thesis, the potential of biomarkers and of ROTEM to estimate risks of hemostatic complications from coagulopathies in the critically ill and injured is explored.