Rotational Thromboelastometry for Assessing Bleeding Complications and Factor XIII Deficiency in Cardiac Surgery Patients

Raspé, Christoph; Besch, Maximilian; Charitos, Efstratios I.; Flöther, Lilit; Bucher, Michael; Rückert, Florian; Treede, Hendrik

doi:10.1177/1076029618797472

Cited by 20 publications

(16 citation statements)

References 27 publications

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“…As FXIII circulates in a complex with fibrinogen, fibrinogen levels could be a marker of FXIII activity. 16,27 However, similarly to other authors, 17 we did not find any correlation between FXIII deficiency and a drop in fibrinogen levels, suggesting that fibrinogen might not be an accurate predictor of FXIII deficiency. Since rapid evaluation of FXIII levels is not available in most centers, FXIII deficiency could be indirectly investigated through viscoelastic assays.…”

Section: Discussionsupporting

confidence: 80%

“…28 Nonetheless, impaired clot firmness in the ExTEM assay (which activates hemostasis via the activator tissue factor) and the FibTEM assay (which measures the fibrin part of the clot) has been shown to correlate with FXIII concentrations in several clinical studies. 15,17,27 These tests could possibly be harnessed to optimize clinical management through bedside monitoring.…”

Section: Discussionmentioning

confidence: 99%

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Acquired FXIII Deficiency is Associated with High Morbidity

et al. 2021

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Background: A factor XIII (FXIII) level >30% is considered necessary to prevent spontaneous bleeding. Bleeding is also a risk in patients with acquired FXIII deficiency, but the hemostatic level of FXIII in this context remains to be determined. Material & Methods: We retrospectively analyzed all patients diagnosed with acquired FXIII deficiency at a large hospital over 3 years (study ID NCT04416594, http://www.clinicaltrials.gov) and assessed clinical data to identify the best cut-off point for FXIII activity to distinguish between low and high risk of major bleeding in a mixed medical and surgical population. Results: Of the 97 patients who experienced bleeding despite a normal coagulation test, 43.2% had FXIII activity <70%. FXIII activity was significantly lower in surgical patients and patients admitted to the intensive care unit (ICU). Low FXIII activity was significantly associated with long ICU stays and a high incidence of major bleeding. Conclusions: Acquired FXIII deficiency is associated with high morbidity. The hemostatic level of FXIII in the setting of acquired FXIII deficiency might be above 30%.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Acquired FXIII Deficiency is Associated with High Morbidity

et al. 2021

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“…With a cut-off value of 25 mm for A5 EX (35 mm for A10 EX and 45 mm for MCF EX ) and a cut-off value of 8 mm for A5 FIB (9 mm for A10 FIB and 10 mm for MCF FIB ), lower levels of clot firmness seem to be adequate in liver transplantation compared to the cardiovascular, trauma, and obstetric setting. Notably, FIBTEM is superior to predict bleeding in liver transplantation compared to plasma fibrinogen concentration since it does not only assess the quantity of fibrinogen but also fibrin polymerization that is affected by dysfibrinogens, factor XIII activity, and colloids [110][111][112][113]. Implementation of FIBTEM-guided fibrinogen substitution in bleeding management algorithms during liver transplantation significantly reduced transfusion requirements for red blood cells, plasma, and platelets [31,92,97,101,[114][115][116][117][118].…”

Section: Vol 72 No 4 August 2019mentioning

confidence: 99%

The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management

Görlinger

Pérez-Ferrer

Dirkmann

et al. 2019

Korean J Anesthesiol

178

138

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Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic method and enables to assess viscoelastic profiles of whole blood in various clinical settings. ROTEM-guided bleeding management has become an essential part of patient blood management (PBM) which is an important concept in improving patient safety. Here, ROTEM testing and hemostatic interventions should be linked by evidence-based, setting-specific algorithms adapted to the specific patient population of the hospitals and the local availability of hemostatic interventions. Accordingly, ROTEM-guided algorithms implement the concept of personalized or precision medicine in perioperative bleeding management ('theranostic' approach). ROTEM-guided PBM has been shown to be effective in reducing bleeding, transfusion requirements, complication rates, and health care costs. Accordingly, several randomized-controlled trials, meta-analyses, and health technology assessments provided evidence that using ROTEM-guided algorithms in bleeding patients resulted in improved patient's safety and outcomes including perioperative morbidity and mortality. However, the implementation of ROTEM in the PBM concept requires adequate technical and interpretation training, education and logistics, as well as interdisciplinary communication and collaboration. Fig. 1. ROTEM trace ('temogram') displaying the clinically most important parameters and their informative value. FDPs: fibrin (ogen) split products. Courtesy of Klaus Görlinger, Germany.

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“…Based on our findings, EXTEM A5 and EXTEM A10 proved to be stronger predictors of hemorrhage in thrombocytopenic neonates compared to ROTEM variables based on clot elasticity and platelet component. This finding could be attributed to the fact that EXTEM A5 and EXTEM A10 encompass platelet count, platelet function, fibrinogen concentration, fibrin polymerization, and factor XIII contribution in clot firmness 22,23 . Therefore, they better reflect the compensatory effect of increased fibrin polymerization on decreased platelet count in thrombocytopenic patients 24,25 .…”

Section: Discussionmentioning

confidence: 99%

“…This finding could be attributed to the fact that EXTEM A5 and EXTEM A10 encompass platelet count, platelet function, fibrinogen concentration, fibrin polymerization, and factor XIII contribution in clot firmness. 22,23 Therefore, they better reflect the compensatory effect of increased fibrin polymerization on decreased platelet count in thrombocytopenic patients. 24,25 This effect is also demonstrated in our study, by the significantly higher FIBTEM A10…”

Section: Discussionmentioning

confidence: 99%

The role of ROTEM variables based on clot elasticity and platelet component in predicting bleeding risk in thrombocytopenic critically ill neonates

Parastatidou

Sokou

Tsantes

et al. 2020

European J of Haematology

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Background Our aim was to investigate the role of thromboelastometry (ROTEM) parameters, including maximum clot elasticity (MCE) and platelet component (PLTEM MCE and PLTEM MCF), in early prediction of bleeding events in thrombocytopenic critically ill neonates. Material and methods This single‐center, prospective cohort study included 110 consecutive thrombocytopenic neonates with sepsis, suspected sepsis, or hypoxia. On the first day of disease onset, ROTEM EXTEM and FIBTEM assays were performed and the neonatal bleeding assessment tool was used for the evaluation of bleeding events. Results Most EXTEM and FIBTEM ROTEM parameters significantly differed between neonates with (n = 77) and without bleeding events (n = 33). Neonates with bleeding events had significantly lower PLTEM MCE and PLTEM MCF values compared to those without bleeding events (P < .001). Platelet count was found to be strongly positively correlated with EXTEM A5 (Spearman's rho = 0.61, P < .001) and A10 (rho = 0.64, P < .001). EXTEM A10 demonstrated the best prognostic performance (AUC = 0.853) with an optimal cutoff value (≤37 mm) (sensitivity = 91%, specificity = 76%) for prediction of bleeding events in thrombocytopenic neonates. Conclusions EXTEM A5 and EXTEM A10 were found to be strong predictors of hemorrhage, compared to most ROTEM variables quantifying clot elasticity and platelet component in thrombocytopenic critically ill neonates.

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Rotational Thromboelastometry for Assessing Bleeding Complications and Factor XIII Deficiency in Cardiac Surgery Patients

Cited by 20 publications

References 27 publications

Acquired FXIII Deficiency is Associated with High Morbidity

Acquired FXIII Deficiency is Associated with High Morbidity

The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management

The role of ROTEM variables based on clot elasticity and platelet component in predicting bleeding risk in thrombocytopenic critically ill neonates

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