Rotational Thromboelastometry Predicts Transfusion Requirements in Total Joint Arthroplasties

Abstract

The frequency of red blood cell (RBC) transfusions is high in total joint arthroplasties, and the hemorrhagic risk is associated with both surgery- and patient-related factors. This study aims to assess the ability of rotational thromboelastometry (ROTEM) to identify patients at high risk for transfusion and excessive bleeding. A prospective observational study was conducted including 206 patients who underwent total knee or hip arthroplasties. Assessment of the coagulation status was performed preoperatively and immediately postoperatively using ROTEM analysis and conventional coagulation tests. The number of RBC transfusions and the postoperative hemoglobin drop were recorded. ROTEM findings were compared between transfused and nontransfused patients, and also between patients with and without excessive bleeding. Higher values of postoperative FIBTEM maximum clot firmness (MCF) were associated with lower risks of transfusion (odds ration [OR]: 0.66, 95% confidence interval [CI]: 0.57–0.78, p<0.001) and excessive bleeding (OR: 0.58, 95% CI: 0.36–0.94, p=0.028). A postoperative FIBTEM MCF value ≤10mm had 80.1% (95% CI: 73.1–85.9%) sensitivity with 75.5% (95% CI: 60.4–87.1%) specificity to predict transfusion requirements, and 70.5% (95% CI: 63.6–76.8%) sensitivity with 88.8% (95% CI: 51.7–99.7%) specificity to predict excessive bleeding. The estimated average probability of transfusion in patients with FIBTEM MCF values of 0 to 4mm is 86.3%. ROTEM assay demonstrated high predictive ability for transfusion and excessive bleeding. Identification of patients at risk for transfusion could allow blood banks to ensure adequate blood supply, while also more intense blood-salvaging strategies could be implemented in these patients.

The Acute and Chronic Effects of Resistance and Aerobic Exercise in Hemostatic Balance: A Brief Review

“…Future research might focus on combining different exercise modes [242,243] and manipulating each component separately, such as bout duration [165,244] or investigating for the minimal dose needed to attain the benefits of a training program in maintaining hemostatic balance. Moreover, most advanced laboratory methods for the evaluation of hemostasis such as viscoelastic studies may be valuable in order to further clarify which part of the coagulation mechanism is most affected by different types of exercise [117,[245][246][247].…”

Basic Principles of Rotational Thromboelastometry (ROTEM®) and the Role of ROTEM—Guided Fibrinogen Replacement Therapy in the Management of Coagulopathies

“…In particular, postoperative FIBTEM MCF ≤ 15 mm had significant sensitivity and specificity for the prognosis of excessive bleeding, and similarly, preoperative FIBTEM MCF ≤ 15 mm had high sensitivity and specificity for the prognosis of increased transfusion requirements. The ROTEM test was a better predictor of transfusion or excessive bleeding, which allows blood banks to ensure adequate blood supply or to develop blood salvaging strategies when treating these patients [19].…”

Rotational Thromboelastometry as a Diagnostic Tool for Persistent Infection in Two-Stage Exchange Arthroplasty

“…Rotational thromboelastometry (ROTEM) is a laboratory approach that evaluates the coagulation mechanism through a thorough analysis of the viscoelastic properties of whole blood specimens. Compared to conventional coagulation studies, ROTEM analysis has the advantage of evaluating all phases of hemostasis from clot formation to clot breakdown, while it has been shown to have a high diagnostic accuracy for detecting coagulation derangements that are associated with various pathologies such as thromboembolic complications and excessive bleeding [13].…”