The Application of ROTEM in a Parturient With Antiphospholipid Syndrome in the Setting of Anticoagulation for Cesarean Delivery: A Case Report

Fiol, Antonio Gonzalez; Fardelmann, Kristen L.; McGuire, Patsy J; Merriam, Audrey; Miller, Arnold; Alian, Aymen

doi:10.1213/xaa.0000000000001182

Cited by 3 publications

(2 citation statements)

References 12 publications

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“…In the available literature, we found only episodic cases of the use of ROTEM for the hemostasis assessment and subsequent guidance of the use of LMWH in such high-risk pregnancy. In the case report of pregnant woman with antiphospholipid syndrome and HELLP syndrome who underwent a cesarean section 9 h after the use of heparin, HEPTEM assay helped to confirm heparin neutralization and manage intraoperative transfusion administration [ 54 ]. In another study of 97 women undergoing cesarean delivery in the presence or absence of LMWH, coagulation tests including ROTEM revealed hypercoagulation present after delivery and a tendency toward the normalization of hemostasis during the early postpartum period.…”

Section: Discussionmentioning

confidence: 99%

How Can Rotational Thromboelastometry as a Point-of-Care Method Be Useful for the Management of Secondary Thromboprophylaxis in High-Risk Pregnant Patients?

et al. 2021

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Thromboprophylaxis with low-molecular-weight heparin (LMWH) for patients with a history of venous thromboembolism (VTE) is suggested. Rotational thromboelastometry (ROTEM®) represents an innovative point-of-care method enabling the complex and quick evaluation of hemostasis. However, there are only episodic cases of its use for hemostasis assessment and guidance of LMWH in pregnancy. Therefore, we provide the results of unique prospective and longitudinal monitoring of hemostasis in high-risk pregnant women, which we used for the individualized optimalization of secondary thromboprophylaxis. According to the shortening of clot formation time (CFT) in EXTEM (p = 0.0007 from the 26th gestational week vs. controls) and INTEM (p = 0.002 from the 35th gestational week), increase in alpha angle (AA) in EXTEM, INTEM, and HEPTEM, and the persistence of increase in maximum clot firmness (MCF) in EXTEM, INTEM, and HEPTEM (p < 0.001 from the 26th and 35th gestational week vs. controls for EXTEM and INTEM, p = 0.0012 from the 26th gestational week in HEPTEM), LMWH dose was modified. Even after the postpartum period, AA in EXTEM was steeper than in controls (p = 0.0007), indicating that hemostasis is not fully normalized after 6–8 weeks following delivery. Therefore, ROTEM may be a useful tool for the individual evaluation of the termination of anticoagulant thromboprophylaxis.

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Section: Discussionmentioning

confidence: 99%

How Can Rotational Thromboelastometry as a Point-of-Care Method Be Useful for the Management of Secondary Thromboprophylaxis in High-Risk Pregnant Patients?

et al. 2021

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“…88 Until now there are only a few reports on the use of ROTEM to predict the coagulation status of patients with APS. 89,90 Hensch et al studied 11 young patients with LA using ROTEM, for identifying the effect of LA on ROTEM EXTEM and INTEM assays. The authors did not carry out other ROTEM assays including FIBTEM.…”

Section: Rotem Assaysmentioning

confidence: 99%

Laboratory Approaches to Test the Function of Antiphospholipid Antibodies

Szabó

Antal‐Szalmás

Kerényi

et al. 2021

Semin Thromb Hemost

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Antiphospholipid syndrome (APS) is a systemic autoimmune disorder caused by the presence of aPLs (antiphospholipid antibodies, i.e., anti-β2-glycoprotein I and anti-cardiolipin). Everyday practice in terms of laboratory diagnostics of APS includes determination of aPLs and well-known functional assays assessing for lupus anticoagulant (LA), in turn using various tests. According to recent guidelines, the recommended method for LA identification or exclusion is based on the Russell Viper Venom test and a sensitive activated partial thromboplastin time assay. Despite the fact that LA can be quantified in laboratory practice in this way, LA is still used as a binary parameter that is just one of the risk factors of thrombosis in APS. As of today, there are no other functional assays to routinely assess the risk of thrombosis in APS. It is well-known that APS patients display a wide range of clinical outcomes although they may express very similar laboratory findings. One way to solve this dilemma, could be if antibodies could be further delineated using more advanced functional tests. Therefore, we review the diagnostic approaches to test the function of aPLs. We further discuss how thrombin generation assays, and rotational thromboelastometry tests can be influenced by LA, and how experimental methods, such as flow cytometric platelet activation, surface plasmon resonance, or nano differential scanning fluorimetry can bring us closer to the puzzling interaction of aPLs with platelets as well as with their soluble protein ligand. These novel approaches may eventually enable better characterization of aPL, and also provide a better linkage to APS pathophysiology.

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Heparin

2020

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The Application of ROTEM in a Parturient With Antiphospholipid Syndrome in the Setting of Anticoagulation for Cesarean Delivery: A Case Report

Cited by 3 publications

References 12 publications

How Can Rotational Thromboelastometry as a Point-of-Care Method Be Useful for the Management of Secondary Thromboprophylaxis in High-Risk Pregnant Patients?

How Can Rotational Thromboelastometry as a Point-of-Care Method Be Useful for the Management of Secondary Thromboprophylaxis in High-Risk Pregnant Patients?

Laboratory Approaches to Test the Function of Antiphospholipid Antibodies

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