Does Rotational Thromboelastometry (ROTEM) Improve Prediction of Bleeding After Cardiac Surgery?

Lee, Grace C.; Kicza, Adrienne M.; Liu, Kuang-Yu; Nyman, Charles; Kaufman, Richard M.; Body, Simon C.

doi:10.1213/ane.0b013e31825e7c39

Cited by 46 publications

(40 citation statements)

References 33 publications

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“…FIBTEM MCF at the ICU admission demonstrated a higher predictive ability for blood loss than the other tests, but this was not significantly different from plasma fibrinogen level. Lee et al 13 did also investigate ROTEM's predictive value for chest tube drainage after cardiac surgery with CPB in 321 patients. From this study, it was concluded that ROTEM did not substantially improve prediction of chest tube drainage, beyond routine clinical and laboratory variables, although some ROTEM variables were independently associated with chest tube drainage post CPB.…”

Section: Discussionmentioning

confidence: 99%

“…That ROTEM is only moderately associated with the prediction of blood loss is not surprising, given the numerous factors related to blood loss in cardiac surgical patients, like surgical bleeding, acidosis, CPB time, and body weight. 13,29 However, the advantage of ROTEM compared to plasma fibrinogen levels is that the test has shorter turnaround times, it gives information about the complete haemostatic profile of the patient, and it could therefore be a faster method to guide haemostatic therapy. This study had limited sample size, but was large enough to detect statistically significant AUCs for various ROTEM parameters.…”

Section: Discussionmentioning

confidence: 99%

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The association between rotational thromboelastometry parameters and blood loss after cardiac surgery with cardiopulmonary bypass

Bosch

Weerwind

Cate

et al. 2015

Cardiovascular and Thoracic Open

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Background: The objectives of this study were to investigate the changes in routine laboratory tests and rotational thromboelastometry variables after cardiopulmonary bypass and to investigate the association of these variables with postoperative blood loss. Methods: Blood was obtained at baseline, at admission to the intensive care unit, and at the first postoperative day. Rotational thromboelastometry tests and measurements of haemoglobin, haematocrit, platelet count, and plasma fibrinogen level (Clauss method) were performed. Excessive bleeding was defined as >1000 mL of chest tube drainage after surgery within 24 h. Results: After cardiopulmonary bypass, haemotocrit was decreased by 21%. Platelet count and fibrinogen level decreased more (35% and 42%, respectively). The largest change was found for clot formation time of INTEM (intrinsically activated coagulation) (+73%). Platelet count was not reflected by maximal clot firmness of PLATEM (platelet component specific coagulation). The decreases in FIBTEM (fibrinogen specific coagulation) maximum clot firmness and fibrinogen at the intensive care unit admission were comparable. Test results outside the reference range were associated with higher median blood loss when compared to values within the reference range, with most significant association for fibrinogen (p < 0.001) and FIBTEM maximal clot firmness (p = 0.016). At baseline, the ability of rotational thromboelastometry parameters to predict postoperative blood loss >1000 mL is higher than the predictive value of fibrinogen (area under the curve = 0.642; 95% confidence interval: 0.487-0.796), but only areas under the curve of APTEM (extrinsically activated coagulation with exclusion of fibrinolysis component) were significantly higher (p⩽0.05). At intensive care unit admission, the highest area under the curve was 0.689 (95% confidence interval: 0.549-0.828) for FIBTEM maximum clot firmness. Conclusion: Rotational thromboelastometry could be a useful point-of-care method to monitor haemostasis because it is a faster and more informative method, and it has a slightly higher predictive ability for blood loss compared to fibrinogen.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The association between rotational thromboelastometry parameters and blood loss after cardiac surgery with cardiopulmonary bypass

Bosch

Weerwind

Cate

et al. 2015

Cardiovascular and Thoracic Open

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“…68 Similarly, a prolonged activated partial thromboplastin time (aPTT, a measure of the intrinsic and common coagulation pathways) is independently associated with failure of hemostasis after rFVIIa for refractory hemorrhage. 69 Addressing concomitant deficiencies of other coagulation components before administering rFVIIa is, therefore, prudent. Conversely, the use of high-dose rFVIIa followed by correction of these deficiencies may lead to thromboembolic complications.…”

Section: 61mentioning

confidence: 99%

Prothrombin Complex Concentrates for Bleeding in the Perioperative Setting

Ghadim

Levy

Welsby

2016

Survey of Anesthesiology

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“…Different studies [135][136][137][138][139][140][141][142] reported these systems to be predictive of risk of increased postoperative bleeding. Other reports have stated the use of different parameters provided by these tests are predictors of both postoperative bleeding and blood product use [143][144][145] .…”

Section: Viscoelastic Methodsmentioning

confidence: 99%

Assessment of platelet function: Laboratory and point-of-care methods

Paniccia¹

2014

WJTM

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In the event of blood vessel damage, human platelets are promptly recruited on the site of injury and, after their adhesion, activation and aggregation, prevent blood loss with the formation of a clot. The consequence of abnormal regulation can be either hemorrhage or the development of thrombosis. Qualitative and/or quantitative defects in platelets promote bleeding, whereas the residual reactivity of platelets, despite antiplatelet therapies, play an important role in promoting arterial thrombotic complications. Platelet function is traditionally assessed to investigate the origin of a bleeding syndrome, to predict the risk of bleeding prior surgery or during pregnancy or to monitor the efficacy of antiplatelet therapy in thrombotic syndromes that, now, can be considered a new discipline. "Old" platelet function laboratory tests such as the evaluation of bleeding time and the platelet aggregation analysis in platelet-rich plasma are traditionally utilized to aid in the diagnosis and management of patients with platelet and hemostatic disorders and used as diagnostic tools both in bleeding and thrombotic diathesis in specialized laboratories. Now, new and renewed automated systems have been introduced to provide a simple, rapid assessment of platelet function including point of care methods. These new methodologies are also suitable for being used in non-specialized laboratories and in critical area for assessing platelet function in whole blood without the requirement of sample processing. Some of these methods are also beginning to be incorporated into routine clinical use and can be utilized as not only as first panel for the diagnosis of platelet dysfunction, but also for monitoring anti-platelet therapy and to potentially assess risk of both bleeding and/or thrombosis.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Platelets; Method; Test; Point of care testing; Laboratory assessment; Bleeding; Thrombosis; Platelet function Core tip: This review discussed the scenario of available platelet function laboratory and point-of-care methods suitable in different clinical setting. As this matter has become of crucial importance in the bleeding management and for monitoring antiplatelet therapies, improved ability to assess platelet function in a timely and efficient manner is essential. Traditional platelet function methods, requiring a fair degree of expertise, have been limited to specialized laboratory. Many efforts have been carried out for improving platelet function assays for centralized laboratory, such as different point-of-care testing methodologies have been developed. Moreover, different guidelines and recommendations for their method standardization are growing.

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Does Rotational Thromboelastometry (ROTEM) Improve Prediction of Bleeding After Cardiac Surgery?

Cited by 46 publications

References 33 publications

The association between rotational thromboelastometry parameters and blood loss after cardiac surgery with cardiopulmonary bypass

The association between rotational thromboelastometry parameters and blood loss after cardiac surgery with cardiopulmonary bypass

Prothrombin Complex Concentrates for Bleeding in the Perioperative Setting

Assessment of platelet function: Laboratory and point-of-care methods

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