Whole blood coagulation assessment using rotation thrombelastogram thromboelastometry in patients with acute deep vein thrombosis

Abstract

Common tests for the assessment of blood coagulation in the acute phase of deep vein thrombosis are of limited value for the evaluation of the associated hypercoagulability. The new rotation thromboelastometry by rotation thrombelastogram has the potential to provide information on whole blood clot formation and prothrombotic state in patients with acute deep vein thrombosis. Rotation thrombelastogram parameters were evaluated in whole blood of 30 patients with a first episode of acute deep vein thrombosis and 40 healthy controls. The effect of factor VIII and fibrinogen levels on rotation thrombelastogram assays was also assessed in the study population and in a model of blood supplemented by increasing amounts of fibrinogen. All assays performed were consistent with a remarkable hypercoagulable profile in deep vein thrombosis patients as compared with controls. In particular, maximum clot firmness and the area under curve values, which are expected to better correlate with the hypercoagulable state in the acute phase of deep vein thrombosis, were significantly higher in patients than in controls. As expected, fibrinogen was shown to be one of the main determinants of the hypercoagulability in rotation thrombelastogram assays. In a small subset of acute deep vein thrombosis patients, inherited thrombophilia had no influence on rotation thrombelastogram parameters. The new rotation thrombelastogram thromboelastometry is a useful tool to detect acute deep vein thrombosis-related hypercoagulability. Prospective studies are needed to define the potential applications of rotation thrombelastogram in the management of deep vein thrombosis patients.

Persistence of Hypercoagulable State after Resection of Intra-Abdominal Malignancies

“…More recently, ROTEM demonstrated relative hypercoagulability in patients with clinically significant deep vein thrombosis (DVT) vs healthy controls. 26 Burke and colleagues 10 demonstrated that patients undergoing simultaneous kidney/pancreas transplantation for type 1 diabetes/end-stage renal disease were more hypercoagulable on TEG (lower K, higher maximum amplitude, alpha and TEG index) than those receiving isolated kidney transplants. In a heterogeneous population of patients undergoing major elective noncardiac surgery, altered TEG within 2 hours of surgery was predictive of postoperative myocardial infarction.…”

Thromboelastographic predictors of venous thromboembolic events in critically ill patients

“…Amongst the thromboelastographic parameters explored, the investigators founded that TDR had the highest sensitivity and specificity in predicting the postulated prophylactic range of anti-Xa [21]. An association between thromboembolic events and thromboelastographic and thromboelastometric parameters has also been shown, especially in the critically ill patient population [29][30][31][32].…”

Multicentric comparison of single portion reagents and liquid reagents for thromboelastometry

“…ROTEM uses several different activators to assess the initiation, propagation and stability of the clot. By adding specific inhibitors, tracings of clot formation can be obtained that facilitate the rapid diagnosis of hyperfibrinogenemia, hypofibrinogenemia, afibrinogenemia and dysfibrinogenemia [11][12][13], the diagnosis of hyperfibrinolysis [7,14] and the detection of the presence of heparin in the blood sample [1]. In addition, the impairment of fibrin polymerization induced by volume replacement with colloids or crystalloids perioperatively may also be detected by this method [15].…”