Rotational thromboelastometry and conventional coagulation tests in patients undergoing major cardiac or aortic surgery: a retrospective single-center cohort study
Algorithms for treatment of diffuse bleeding in cardiac surgery are based on intervention thresholds of coagulation tests, such as rotational thromboelastometry (ROTEM) or conventional laboratory tests. The relationship between these two approaches is unclear in patients with increased risk of coagu...
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| Veröffentlicht in: | Journal of thrombosis and thrombolysis 2022-01, Vol.53 (1), p.149-157 |
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| creator | Keyl, Cornelius Bashota, Albina Beyersdorf, Friedhelm Trenk, Dietmar |
| description | Algorithms for treatment of diffuse bleeding in cardiac surgery are based on intervention thresholds of coagulation tests, such as rotational thromboelastometry (ROTEM) or conventional laboratory tests. The relationship between these two approaches is unclear in patients with increased risk of coagulation abnormalities. We retrospectively analyzed the data of 248 patients undergoing major cardiac and/or aortic surgery. ROTEM and conventional laboratory tests were performed simultaneously after termination of cardiopulmonary bypass and protamine administration to investigate the extrinsic and intrinsic system, and to determine deficiencies in platelets and fibrinogen. We evaluated the association between ROTEM and conventional tests by linear regression analysis and compared the frequency of exceeding established thresholds for clinical intervention. Significant linear associations between ROTEM 10 min after the start of coagulation, and plasma fibrinogen concentration or platelet count (FIBTEM A10, R
2
= 0.67, p |
| doi_str_mv | 10.1007/s11239-021-02519-y |
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2
= 0.67, p < 0.001; EXTEM A10, R
2
= 0.47, p < 0.001) were obtained. However, the 95% prediction intervals exceeded clinically useful ranges (92–233 mg/dL fibrinogen at the intervention threshold of FIBTEM A10 = 10 mm; 14 × 10
3
–122 × 10
3
/µL platelets at the intervention threshold of EXTEM A10 = 40 mm). The association between EXTEM and INR (R
2
= 0.23), and INTEM and aPTT (R
2
= 0.095) was poor. The frequency of exceeding intervention thresholds and, consequently, of triggering treatment, varied markedly between ROTEM and conventional tests (p < 0.001 for all comparisons). The predictability of conventional coagulation test results by ROTEM is limited, thus hampering the interchangeability of methods in clinical practice.</description><identifier>ISSN: 0929-5305</identifier><identifier>EISSN: 1573-742X</identifier><identifier>DOI: 10.1007/s11239-021-02519-y</identifier><identifier>PMID: 34232454</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Aorta ; Cardiology ; Coagulation ; Cohort analysis ; Fibrinogen ; Heart ; Heart surgery ; Hematology ; Laboratories ; Medicine ; Medicine & Public Health ; Patients ; Platelets ; Protamine sulfate ; Surgery</subject><ispartof>Journal of thrombosis and thrombolysis, 2022-01, Vol.53 (1), p.149-157</ispartof><rights>The Author(s) 2021</rights><rights>2021. The Author(s).</rights><rights>The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-c83c7194038380e995eb2580c24764e038349110c8fc9092895430dc3b2e9ef3</citedby><cites>FETCH-LOGICAL-c474t-c83c7194038380e995eb2580c24764e038349110c8fc9092895430dc3b2e9ef3</cites><orcidid>0000-0002-1818-4819</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11239-021-02519-y$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11239-021-02519-y$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34232454$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Keyl, Cornelius</creatorcontrib><creatorcontrib>Bashota, Albina</creatorcontrib><creatorcontrib>Beyersdorf, Friedhelm</creatorcontrib><creatorcontrib>Trenk, Dietmar</creatorcontrib><title>Rotational thromboelastometry and conventional coagulation tests in patients undergoing major cardiac or aortic surgery: a retrospective single-center cohort study</title><title>Journal of thrombosis and thrombolysis</title><addtitle>J Thromb Thrombolysis</addtitle><addtitle>J Thromb Thrombolysis</addtitle><description>Algorithms for treatment of diffuse bleeding in cardiac surgery are based on intervention thresholds of coagulation tests, such as rotational thromboelastometry (ROTEM) or conventional laboratory tests. The relationship between these two approaches is unclear in patients with increased risk of coagulation abnormalities. We retrospectively analyzed the data of 248 patients undergoing major cardiac and/or aortic surgery. ROTEM and conventional laboratory tests were performed simultaneously after termination of cardiopulmonary bypass and protamine administration to investigate the extrinsic and intrinsic system, and to determine deficiencies in platelets and fibrinogen. We evaluated the association between ROTEM and conventional tests by linear regression analysis and compared the frequency of exceeding established thresholds for clinical intervention. Significant linear associations between ROTEM 10 min after the start of coagulation, and plasma fibrinogen concentration or platelet count (FIBTEM A10, R
2
= 0.67, p < 0.001; EXTEM A10, R
2
= 0.47, p < 0.001) were obtained. However, the 95% prediction intervals exceeded clinically useful ranges (92–233 mg/dL fibrinogen at the intervention threshold of FIBTEM A10 = 10 mm; 14 × 10
3
–122 × 10
3
/µL platelets at the intervention threshold of EXTEM A10 = 40 mm). The association between EXTEM and INR (R
2
= 0.23), and INTEM and aPTT (R
2
= 0.095) was poor. The frequency of exceeding intervention thresholds and, consequently, of triggering treatment, varied markedly between ROTEM and conventional tests (p < 0.001 for all comparisons). The predictability of conventional coagulation test results by ROTEM is limited, thus hampering the interchangeability of methods in clinical practice.</description><subject>Aorta</subject><subject>Cardiology</subject><subject>Coagulation</subject><subject>Cohort analysis</subject><subject>Fibrinogen</subject><subject>Heart</subject><subject>Heart surgery</subject><subject>Hematology</subject><subject>Laboratories</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Patients</subject><subject>Platelets</subject><subject>Protamine sulfate</subject><subject>Surgery</subject><issn>0929-5305</issn><issn>1573-742X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kstuEzEUhi1ERUPhBVggS2zYDPVtMmMWSFXFTaqEhLpgZzmek4mjGTvYnkjzPLwoJ00otAsWlm_f_5_j40PIK87eccaay8y5kLpiguOoua7mJ2TB60ZWjRI_npIF00JXtWT1OXme85YxpjUTz8i5VEIKVasF-fU9Flt8DHagZZPiuIow2FziCCXN1IaOuhj2EE6Mi7afhjsFLZBLpj7QHe6RyHQKHaQ--tDT0W5jos6mzltHcWljKt7RPKUe0vyeWpowRMw7cMXvgWZUDVA5NAIUxg3yNJepm1-Qs7UdMrw8zRfk9tPH2-sv1c23z1-vr24qpxpVKtdK13CtmGxly0DrGlaibpkTqlkqOBwrzTlz7dppLE2rayVZ5-RKgIa1vCAfjra7aTVCd0gk2cHskh9tmk203jy8CX5j-rg3baO5FhwN3p4MUvw5YXHM6LODYbAB4pSNqJUWQjKuEX3zCN3GKWGBkVoK0S6ZWh4ocaQc1iknWN8nw5k5tIA5toDBFjB3LWBmFL3-9xn3kj9_joA8AhmvAn7G39j_sf0N_bvCFw</recordid><startdate>20220101</startdate><enddate>20220101</enddate><creator>Keyl, Cornelius</creator><creator>Bashota, Albina</creator><creator>Beyersdorf, Friedhelm</creator><creator>Trenk, Dietmar</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-1818-4819</orcidid></search><sort><creationdate>20220101</creationdate><title>Rotational thromboelastometry and conventional coagulation tests in patients undergoing major cardiac or aortic surgery: a retrospective single-center cohort study</title><author>Keyl, Cornelius ; Bashota, Albina ; Beyersdorf, Friedhelm ; Trenk, Dietmar</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-c83c7194038380e995eb2580c24764e038349110c8fc9092895430dc3b2e9ef3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aorta</topic><topic>Cardiology</topic><topic>Coagulation</topic><topic>Cohort analysis</topic><topic>Fibrinogen</topic><topic>Heart</topic><topic>Heart surgery</topic><topic>Hematology</topic><topic>Laboratories</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Patients</topic><topic>Platelets</topic><topic>Protamine sulfate</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Keyl, Cornelius</creatorcontrib><creatorcontrib>Bashota, Albina</creatorcontrib><creatorcontrib>Beyersdorf, Friedhelm</creatorcontrib><creatorcontrib>Trenk, Dietmar</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of thrombosis and thrombolysis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Keyl, Cornelius</au><au>Bashota, Albina</au><au>Beyersdorf, Friedhelm</au><au>Trenk, Dietmar</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rotational thromboelastometry and conventional coagulation tests in patients undergoing major cardiac or aortic surgery: a retrospective single-center cohort study</atitle><jtitle>Journal of thrombosis and thrombolysis</jtitle><stitle>J Thromb Thrombolysis</stitle><addtitle>J Thromb Thrombolysis</addtitle><date>2022-01-01</date><risdate>2022</risdate><volume>53</volume><issue>1</issue><spage>149</spage><epage>157</epage><pages>149-157</pages><issn>0929-5305</issn><eissn>1573-742X</eissn><abstract>Algorithms for treatment of diffuse bleeding in cardiac surgery are based on intervention thresholds of coagulation tests, such as rotational thromboelastometry (ROTEM) or conventional laboratory tests. The relationship between these two approaches is unclear in patients with increased risk of coagulation abnormalities. We retrospectively analyzed the data of 248 patients undergoing major cardiac and/or aortic surgery. ROTEM and conventional laboratory tests were performed simultaneously after termination of cardiopulmonary bypass and protamine administration to investigate the extrinsic and intrinsic system, and to determine deficiencies in platelets and fibrinogen. We evaluated the association between ROTEM and conventional tests by linear regression analysis and compared the frequency of exceeding established thresholds for clinical intervention. Significant linear associations between ROTEM 10 min after the start of coagulation, and plasma fibrinogen concentration or platelet count (FIBTEM A10, R
2
= 0.67, p < 0.001; EXTEM A10, R
2
= 0.47, p < 0.001) were obtained. However, the 95% prediction intervals exceeded clinically useful ranges (92–233 mg/dL fibrinogen at the intervention threshold of FIBTEM A10 = 10 mm; 14 × 10
3
–122 × 10
3
/µL platelets at the intervention threshold of EXTEM A10 = 40 mm). The association between EXTEM and INR (R
2
= 0.23), and INTEM and aPTT (R
2
= 0.095) was poor. The frequency of exceeding intervention thresholds and, consequently, of triggering treatment, varied markedly between ROTEM and conventional tests (p < 0.001 for all comparisons). The predictability of conventional coagulation test results by ROTEM is limited, thus hampering the interchangeability of methods in clinical practice.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>34232454</pmid><doi>10.1007/s11239-021-02519-y</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-1818-4819</orcidid><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | Springer Nature - Complete Springer Journals |
| subjects | Aorta Cardiology Coagulation Cohort analysis Fibrinogen Heart Heart surgery Hematology Laboratories Medicine Medicine & Public Health Patients Platelets Protamine sulfate Surgery |
| title | Rotational thromboelastometry and conventional coagulation tests in patients undergoing major cardiac or aortic surgery: a retrospective single-center cohort study |
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