Clinical Practice
Fast interpretation of thromboelastometry in non-cardiac surgery: reliability in patients with hypo-, normo-, and hypercoagulability

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Background

Conventional coagulation test are not useful to guide haemostatic therapy in severe bleeding due to their long turn-around time. In contrast, early variables assessed by point-of-care thromboelastometry (ROTEM®) are available within 10–20 min and increasingly used to guide haemostatic therapy in liver transplantation and severe trauma. However, the reliability of early ROTEM® variables to predict maximum clot firmness (MCF) in non-cardiac surgery patients with subnormal, normal, and supranormal MCF has not yet been evaluated.

Methods

Retrospective data of 14 162 ROTEM® assays (3939 EXTEM®, 3654 INTEM®, 3287 FIBTEM®, and 3282 APTEM® assays) of patients undergoing non-cardiac surgery were analysed. ROTEM® variables [clotting time (CT), clot formation time (CFT), α-angle, A5, A10, and A15] were related to MCF by linear or non-linear regression, as appropriate. The Bland–Altman analyses to assess the bias between early ROTEM® variables and MCF and receiver operating characteristics (ROC) were also performed.

Results

Taking the best and worst correlation coefficients for each assay type, CT (r=0.18–0.49) showed the worst correlation to MCF. In contrast, α-angle (r=0.85–0.88) and CFT (r=0.89–0.92) demonstrated good but non-linear correlation with MCF. The best and linear correlations were found for A5 (r=0.93–0.95), A10 (r=0.96), and A15 (r=0.97–0.98). ROC analyses provided excellent area under the curve (AUC) values for A5, A10, and A15 (AUC=0.962–0.985).

Conclusions

Early values of clot firmness allow for fast and reliable prediction of ROTEM® MCF in non-cardiac patients with subnormal, normal, and supranormal MCF values and therefore can be used to guide haemostatic therapy in severe bleeding.

blood coagulation
liver transplantation
measurement techniques
postpartum haemorrhage
thromboelastometry
trauma

Cited by (0)

These authors contributed equally to this manuscript.