Disseminated intravascular coagulation (DIC) is a life-threatening coagulopathy characterized by simultaneous widespread activation of coagulation and fibrinolysis, leading to microvascular thrombosis and severe bleeding. Early diagnosis is crucial to improve patient outcomes, yet conventional laboratory tests often fail to capture the dynamic nature of this syndrome in real time. This study aimed to evaluate the diagnostic utility of rotational thromboelastometry (ROTEM) in detecting early-stage DIC and to compare its performance with standard coagulation tests including prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen levels, and D-dimer.A prospective observational study was conducted at a tertiary care center over 24 months. A total of 148 critically ill patients at risk for DIC were enrolled. ROTEM analysis (EXTEM, INTEM, FIBTEM, APTEM) was performed alongside conventional coagulation tests at admission and at 6, 12, and 24 hours. DIC was scored using the International Society on Thrombosis and Haemostasis (ISTH) scoring system. ROTEM detected hemostatic abnormalities significantly earlier than conventional tests. Sensitivity of ROTEM for overt DIC was 91.3% versus 74.6% for standard laboratory tests (p < 0.01). Clot formation time (CFT), clot amplitude at 10 minutes (A10), and maximum clot firmness (MCF) in the FIBTEM assay were the most sensitive ROTEM parameters, showing significant changes up to 4.2 hours earlier than conventional coagulation parameters.

Rotational thromboelastometry (ROTEM); Disseminated intravascular coagulation (DIC); viscoelastic hemostatic assay; point-of-care testing; coagulopathy; critical care; early diagnosis; hemostasis; fibrinolysis; clot formation.

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