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

Abstract

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.

Development and validation of a sepsis diagnostic scoring model for neonates with suspected sepsis

“…Among the ROTEM parameters, EXTEM A10 emerged as the most potent variable in our model for sepsis diagnosis in neonates. This is a parameter which encloses platelet count, platelet function, fibrinogen concentration, factor XIII contribution in clot amplitude, and fibrin polymerization ( 49 ). This finding is in line with existing evidence of a hypocoagulable profile, reflected by reduced EXTEM A10, in septic neonates with hemorrhagic diathesis ( 11 ).…”

The Prognostic Performance of Rotational Thromboelastometry for Excessive Bleeding and Increased Transfusion Requirements in Hip Fracture Surgeries

“…Due to these properties, ROTEM can identify hemostatic abnormalities leading to thrombotic events after hip fracture surgeries, and ROTEM findings have been associated with increased bleeding in other nonsurgical conditions. 10 11 12 13…”

“…Due to these properties, ROTEM can identify hemostatic abnormalities leading to thrombotic events after hip fracture surgeries, and ROTEM findings have been associated with increased bleeding in other nonsurgical conditions. [10][11][12][13] The primary aim of this study was to investigate whether ROTEM findings are associated with excessive bleeding following hip fracture surgeries. The secondary aim was to evaluate the prognostic ability of ROTEM parameters to identify patients at high risk for excessive bleeding following these surgeries, and to evaluate the prognostic capacity of ROTEM parameters to identify patients with increased transfusion requirements.…”

The Utility of NATEM Assay in Predicting Bleeding Risk in Critically Ill Neonates

“…Furthermore, EXTEM parameters quantifying clot elasticity or platelet component were found to be accurate predictors of hemorrhage in thrombocytopenic neonates, with EXTEM A10 presenting as the strongest among them. 30 Increased LI60 (!98%) in EXTEM and NATEM assays, which indicates shutdown of fibrinolysis, 31 was found to be a predictor of clinical bleeding in our study population. Fibrinolysis shutdown represents either inhibition of fibrinolysis following initial activation or primary suppression of fibrinolysis.…”