Rapid and Correct Prediction of Thrombocytopenia and Hypofibrinogenemia With Rotational Thromboelastometry in Cardiac Surgery

R.H.G. Olde Engberink, G.J.A.J.M. Kuiper, R.J.H. Wetzels, P.J. Nelemans, M.D. Lance, E.A.M. Beckers, Y.M.C. Henskens

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objectives: In the present study, the authors have investigated whether rotational thromboelastometry (ROTEM) could predict thrombocytopenia and hypofibrinogenemia in cardiac surgery using the clot amplitude after 5 minutes (A5). Another parameter, PLTEM, in which the contribution of fibrinogen is eliminated by subtracting a fibrin-specific ROTEM test (FIBTEM) from an extrinsically-activated ROTEM test (EXTEM), was investigated. Furthermore, the turnaround time of ROTEM was compared to conventional laboratory tests.

Design: Prospective cohort study.

Setting: Single academic medical center.

Participants: Ninety-seven patients undergoing cardiac surgery between July 2011 until August 2012.

Interventions: The correlations between EXTEM/FIBTEM A5, A10, and maximal clot formation (MCF), EXTEM/PLTEM (A5/A10, and MCF) and platelet count, and FIBTEM (A5/A10, and MCF) and fibrinogen were evaluated using the Pearson's correlation coefficient and receiver-operating characteristic curves. Turnaround times of ROTEM tests and conventional laboratory tests were assessed in the central laboratory.

Measurements and Main Results: EXTEM AS and FIBTEM A5 showed an excellent correlation with A10 (R:0.99/1.00) and MCF (R:0.97/0.99). The correlation between EXTEM AS and platelet count (R:0.74) was comparable with the correlation of A10 (R:0.73) and MCF (R:0.70) with platelet count. FIBTEM AS predicted fibrinogen levels (R:0.87) as well as A10 (R:0.86) and MCF (R:0.87). PLTEM AS (R:0.85) correlated better with platelet count than EXTEM A5 (R:0.74; p = 0.04) and showed significantly better area under the curve values than EXTEM for predicting thrombocytopenia (A5 p = 0.012, A10 p = 0.019). Turnaround time for ROTEM tests, 12 minutes, was comparable with emergency requests for platelet count, 13 minutes, and shorter than emergency requests for fibrinogen levels, 37 minutes.

Conclusions: Implementation of PLTEM and FIBTEM AS in ROTEM-guided transfusion protocols may improve transfusion management. 

Original languageEnglish
Pages (from-to)210-216
Number of pages7
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume28
Issue number2
DOIs
Publication statusPublished - Apr 2014

Keywords

  • ROTEM
  • thromboelastometry
  • thrombocytopenia
  • hypofibrinogenemia
  • cardiac surgery
  • laboratory time
  • BLOOD-TRANSFUSION
  • FIBRINOGEN LEVELS
  • COAGULATION
  • HEMODILUTION
  • REPLACEMENT
  • HEMORRHAGE
  • MANAGEMENT
  • THERAPY
  • TRAUMA

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