Comparison of Thromboelastometry (ROTEM®) With Standard Plasmatic Coagulation Testing in Paediatric Surgery

Abstract

Background. Thromboelastometry (ROTEM(R)) might be useful to detect intraoperative coagulation disorders early in major paediatric surgery. This observational trial compares this technique to standard coagulation tests. Methods. Intraoperative blood sampling was obtained in children undergoing elective major surgery. At each time point, standard coagulation tests [activated partial thromboplastin time (aPTT), prothrombin time (PT), and fibrinogen level] and ROTEM(R) analyses (InTEM, ExTEM, and FibTEM) were performed simultaneously by trained hospital laboratory staff. Results. A total of 288 blood samples from 50 subjects were analysed. While there was a poor correlation between PT and aPTT to ExTEM clotting time (CT) and InTEM CT, respectively, a good correlation was detected between PT and aPTT to clot formation time, and a very good correlation between fibrinogen level and FibTEM assay (r=0.882, P<0.001). Notably, 64% of PT and 94% of aPTT measurements were outside the reference range, while impaired CT was observed in 13% and 6.3%, respectively. Standard coagulation test results were available after a median of 53 min [inter-quartile range (IQR): 45-63 min], whereas 10 min values of ROTEM(R) results were available online after 23 min (IQR: 21-24 min). Conclusions. PT and aPTT cannot be interchangeably used with ROTEM(R) CT. Based on the results of ROTEM(R), recommended thresholds for PT and aPTT might overestimate the need for coagulation therapy. A good correlation was found between the fibrinogen level and the FibTEM assay. In addition, ROTEM(R) offered faster turnaround times.

Thromboelastometry: A contribution to perioperative free-flap management

“…A significant correlation was found for INTEM-CT to pTT. A good correlation was found between the fibrinogen level and the fibrinogen assay additionally applicable (Haas et al, 2012). This was not investigated in our presented data and the data might be of limited transferability to an elderly cohort like ours.…”

“…Based on the results in a study of Haas et al (2012) the recommended thresholds for PT and pTT might overestimate the need for coagulation therapy in pediatric surgery. In a recently published study of Theusinger et al (2013) the clinical assumption was confirmed that EXTEM and INTEM are associated with fibrinogen and platelet concentrations.…”

“…Previously described faster turnaround times than standard testing (Haas et al, 2012) might also allow for early statements on coagulation status in cases of flap-revision. In particular, the differentiation between bleeding from internal or surgical causes, thus avoiding the interruption of potential flap-saving continued heparin-therapy, could be of utmost interest.…”

Documento multidisciplinar de consenso sobre el manejo de la hemorragia masiva (documento HEMOMAS)

“…Se recomienda el método de determinación de Clauss para finalidades diagnósticas o cuando se deban tomar decisiones del manejo clínico de pacientes con HM 153 . La determinación de FIBTEM con ROTEM ® o Functional Fibrinogen en TEG permite detectar de una forma rápida alteraciones en los niveles de Fb en pacientes traumáticos, habiéndose confirmado que la determinación de valores de Fb mediante el test de FIBTEM en el ROTEM ® guardan una estrecha correlación con los valores obtenidos por el método de Clauss 154,155 . Los valores del Fb pueden ser erróneos en las muestras que proceden de pacientes hemodiluidos, y especialmente en aquellos en los que se han administrado coloides.…”

Frühe viskoelastizitätsbasierte Gerinnungstherapie bei blutenden Schwerverletzten

“…Eine INTEM-A15 < 46 mm korrelierte dabei mit einer Sensitivität von 100 % bei einer Spezifität von 83 % mit einer Thrombozytenzahl von 50 • 10 9 /l. In einer weiteren Studie korrelierte die Thrombozytenzahl am besten mit der IN-TEM-A10 (Spearmans p = 0,54) und der EXTEM-A10 (Spearmans p = 0,51; [58] [28]. Bei der "Point-of-care"-Messung verkürzte sich die Rücklaufzeit um weitere 11 auf 12 min, bei gleichbleibender Qualität der Messergebnisse [29].…”