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

• Published in: Journal of cardiothoracic and vascular anesthesia 2014-04, Vol.28 (2), p.210-216
• Main Authors: Olde Engberink, Rik H.G., MD, Kuiper, Gerhardus J.A.J.M., MD, Wetzels, Rick J.H., MSc, Nelemans, Patty J., MD, PhD, Lance, Marcus D., MD, Beckers, Erik A.M., MD, PhD, Henskens, Yvonne M.C., PhD
• Format: Article
• Language: English
• Subjects: Afibrinogenemia - diagnosis; Aged; Anesthesia & Perioperative Care; Area Under Curve; Blood Coagulation Disorders - blood; Blood Coagulation Disorders - diagnosis; Blood Transfusion - methods; cardiac surgery; Cardiac Surgical Procedures - methods; Cohort Studies; Critical Care; Female; Hemoglobins - metabolism; Humans; hypofibrinogenemia; laboratory time; Male; Middle Aged; Platelet Count; Predictive Value of Tests; Prospective Studies; ROC Curve; ROTEM; Thrombelastography - methods; thrombocytopenia; Thrombocytopenia - blood; Thrombocytopenia - diagnosis; thromboelastometry
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2013.12.004

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.