Does rotational thromboelastometry accurately predict coagulation status in patients with lupus anticoagulant?

Hensch, Lisa; Kostousov, Vadim; Bruzdoski, Karen; Losos, Michael; Pereira, Maria Fernanda Bádue; Guzman, Marietta De; Hui, Shiu‐Ki Rocky; Teruya, Jun

doi:10.1111/ijlh.12852

Cited by 10 publications

(6 citation statements)

References 36 publications

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“…The utility of viscoelastometry is to monitor overall primary and secondary (or platelet and coagulation) hemostasis and fibrinolysis. However, the clotting time is prolonged in the presence of "strong" lupus anticoagulant 16 and sensitivity to hyperfibrinolysis is low. In addition, low von Willebrand factor (VWF) levels, a cause of potential bleeding, cannot be detected due to the absence of shear force in the assay system 17 unless factor VIII level is decreased.…”

Section: >80-100%mentioning

confidence: 99%

Bleeding and Thrombotic Complications in the Use of Extracorporeal Membrane Oxygenation

Thomas

Kostousov

Teruya

2017

Semin Thromb Hemost

219

197

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Extracorporeal membrane oxygenation (ECMO) has been used for >40 years to support lung and heart failure; however, bleeding and thrombosis remain serious complications. The known etiologies of bleeding include heparin effect or overdose, coagulopathy, thrombocytopenia, platelet dysfunction, acquired von Willebrand syndrome, and hyperfibrinolysis. Bleeding sites may include cannula insertion sites, recent surgical incisions, vascular access sites, lung, gastrointestinal tract, mouth, nose, thoracic cavity, abdominal cavity, and brain. Massive bleeding in the brain, the most feared bleeding complication, can be rapidly fatal because it occurs in a rigid closed space, is difficult to drain, and cannot be stopped with direct pressure to the bleeding site. Pulmonary hemorrhage may cause irreversible lung damage. Management should be swift and precise to prevent fatal bleeding. In contrast, etiologies of thrombosis include high fibrinogen and factor VIII levels, heparin resistance, and platelet activation. Achieving the optimal anticoagulation balance to prevent bleeding and thrombosis in ECMO patients is extremely complex. Experts in hemostasis should be a part of an institutional ECMO team and continuously available for immediate management.

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Section: >80-100%mentioning

confidence: 99%

Bleeding and Thrombotic Complications in the Use of Extracorporeal Membrane Oxygenation

Thomas

Kostousov

Teruya

2017

Semin Thromb Hemost

219

197

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“…Especially, errors related to coagulation testing can have clinically significant consequences if placing the patient at risk of bleeding or thrombosis ( 7 ). An aPTT > 300 seconds is associated with increased bleeding risk unless the reason is presence of lupus anticoagulant (LA), which is known to cause false prolongation of aPTT ( 8 ). In our case, the aPTT prolongation erroneously indicated that the patient had an increased bleeding risk, which potentially could have influenced the clinical decision-making and postponed further investigations of the patient’s symptoms, if these had included operative procedures contraindicated in case of increased bleeding risk.…”

Section: Discussionmentioning

confidence: 99%

Falsely prolonged activated partial thromboplastin time – a pre- and post-analytical issue

Gils

Vinholt

Nybo

2018

Biochem. med. (Online)

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This case highlights two common pre-analytical problems identified in routine coagulation testing of activated partial thromboplastin time (aPTT), which were overlooked because of a concurrent flag code indicating no coagulation and the result was replaced by asterisks. It concerns a boy with gastrointestinal bleeding and prolonged aPTT > 300 seconds, which raised the suspicion of haemophilia. When all other coagulation parameters (including specific coagulation factors VIII and IX) turned out to be normal, aPTT was re-measured using another analysis principle, which revealed a normal aPTT. The primary aPTT result turned out to be aborted due to concurrent haemolysis and lipaemia, but was erroneously interpreted as prolonged coagulation. The lesson is awareness of the possibility of numerous flag codes on the same sample overruling each other, and awareness on the responsibility in the post-analytical phase that must be carried by increased educational focus and by the manufacturers.

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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: The Effect Of Antiphospholipid Antibodies On Global Hemostas...mentioning

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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Does rotational thromboelastometry accurately predict coagulation status in patients with lupus anticoagulant?

Abstract: Strongly positive LA can prolong the CT on ROTEM studies and lead to erroneous conclusions regarding coagulation status in this patient population.

Cited by 10 publications

References 36 publications

Bleeding and Thrombotic Complications in the Use of Extracorporeal Membrane Oxygenation

Bleeding and Thrombotic Complications in the Use of Extracorporeal Membrane Oxygenation

Falsely prolonged activated partial thromboplastin time – a pre- and post-analytical issue

Laboratory Approaches to Test the Function of Antiphospholipid Antibodies

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