The value of rotation thromboelastometry to monitor disturbed perioperative haemostasis and bleeding risk in patients with cardiopulmonary bypass

Abstract

Rotation thromboelastometry (ROTEM) performed on whole-blood samples provides information on the contribution of fibrinogen and platelets to clot formation. Such measurements are believed superior to classical plasma coagulation measurements as a means of monitoring disturbed haemostasis. On-pump cardiac surgery is associated with high bleeding risk. The study objective was to obtain information on the frequency of abnormal values of ROTEM variables and to assess their value in estimating bleeding risk in such patients. We studied 150 patients undergoing elective on-pump cardiac surgery. We found a significant surgery-induced decrease in haemostatic potential, with more abnormal ROTEM values in intrinsically activated coagulation (up to 50%) than in extrinsically activated coagulation (up to 27%) or the maximum clot firmness in FIBTEM (10%), a test measuring the contribution of fibrinogen. All ROTEM variables tend to normalize within 14-18 h postoperatively. Best positive predictive values and specificity for a postoperative blood loss above 600 ml were found for the clot formation time in extrinsically activated coagulation (71%/94%) and the maximum clot firmness in FIBTEM (73%/95%); these values were superior to the activated partial thromboplastin time or prothrombin time (56%/72% and 43%/5%, respectively). There was no relation between preoperative or early postoperative ROTEM values and intraoperative bleeding. ROTEM recorded a benefit of administration of platelet concentrates or fresh-frozen plasma, particularly when given postoperatively, on haemostasis. In contrast, intraoperative administration of red blood cells impaired haemostasis. ROTEM can provide a more detailed diagnostic basis enabling a focused therapy to cardiac surgery patients with high bleeding risk.

Bleeding risk assessment using whole blood impedance aggregometry and rotational thromboelastometry in patients following cardiac surgery

“…clotting activation via intrinsic or extrinsic pathway), concentration of the stimuli, as well, as due to differences in the recording time of blood loss [37,38]. The definition of what constitutes abnormal postoperative bleeding is difficult.…”

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

“…5 In addition, it is postulated that whole blood tests like ROTEM better reflect disturbances occurring during CPB 7 and may therefore be helpful as a guide for transfusion therapy. [8][9][10] However, the precise relationship between ROTEM values and postoperative bleeding remains unclear. [10][11][12][13][14] The aim of this study was to investigate the changes in routine laboratory tests and ROTEM variables, with subsequent association with blood loss after cardiac surgery with CPB.…”

Beneficial effect of clopidogrel in a mouse model of polymicrobial sepsis

“…Blood cell count, hemoglobin concentration and hematocrit were determined using a POCH -100iV DIFF analyzer (Sysmex). Rotational thromboelastometry (RO-TEM; Pentapharm, Munich, Germany) was used to characterize changes in hemostasis [9,10]. Citrated blood samples (0.3 mL) were used for ROTEM and activated by adding CaCl 2 and a small amount of tissue factor (EXTEM; Pentapharm).…”