From Hypercoagulability to Hypocoagulability: Dynamic ROTEM Phenotypes and Outcomes in Sepsis and Septic Shock

Background/Objectives: Sepsis is characterized by profound and dynamic alterations of haemostasis, ranging from hypercoagulability and fibrinolysis shutdown to mixed patterns, hypocoagulability, and overt disseminated intravascular coagulation. Conventional coagulation tests provide only a partial representation of these changes. Rotational thromboelastometry (ROTEM) offers a whole-blood, dynamic assessment of clot initiation, propagation, firmness, and lysis, potentially allowing for more accurate haemostatic phenotyping.

Methods

A narrative review of the literature was performed using PubMed, Scopus, and EMBASE from database inception to August 2026. Studies addressing sepsis or septic shock and rotational thromboelastometry, thromboelastometry, viscoelastic testing, coagulation phenotypes, fibrinolysis, disseminated intravascular coagulation, and clinical outcomes were considered. Additional references were identified through manual screening of relevant articles and reviews.