Rapid and correct prediction of thrombocytopenia and hypofibrinogenemia with rotational thromboelastometry in cardiac surgery

J Cardiothorac Vasc Anesth. 2014 Apr;28(2):210-6. doi: 10.1053/j.jvca.2013.12.004.

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 A5 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 A5 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 A5 predicted fibrinogen levels (R:0.87) as well as A10 (R:0.86) and MCF (R:0.87). PLTEM A5 (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 A5 in ROTEM-guided transfusion protocols may improve transfusion management.

Keywords: ROTEM; cardiac surgery; hypofibrinogenemia; laboratory time; thrombocytopenia; thromboelastometry.

MeSH terms

  • Afibrinogenemia / diagnosis*
  • Aged
  • Area Under Curve
  • Blood Coagulation Disorders / blood
  • Blood Coagulation Disorders / diagnosis
  • Blood Transfusion / methods
  • Cardiac Surgical Procedures / methods*
  • Cohort Studies
  • Female
  • Hemoglobins / metabolism
  • Humans
  • Male
  • Middle Aged
  • Platelet Count
  • Predictive Value of Tests
  • Prospective Studies
  • ROC Curve
  • Thrombelastography / methods*
  • Thrombocytopenia / blood
  • Thrombocytopenia / diagnosis*

Substances

  • Hemoglobins