Impact of general anesthesia on rotational thromboelastometry (ROTEM) parameters and standard plasmatic coagulation tests in healthy Beagle dogs

Abstract High prevalence of thrombotic events in severely ill COVID-19 patients have been reported. Pulmonary embolism as well as microembolization of vital organs may in these individuals be direct causes of death. The identification of patients at high risk of developing thrombosis may lead to targeted, more effective prophylactic treatment. The primary aim of this study was to test whether rotational thromboelastometry (ROTEM) at admission indicates hypercoagulopathy and predicts the disease severity, assessed as care level, in COVID-19 patients. The study was designed as a prospective, observational study where COVID-19 patients over 18 years admitted to hospital were eligible for inclusion. Patients were divided into two groups depending on care level: (1) regular wards or (2) wards with specialized ventilation support. Conventional coagulation tests, blood type and ROTEM were taken at admission. 60 patients were included; age 61 (median), 67% men, many with comorbidities (e.g. hypertension, diabetes). The ROTEM variables Maximum Clot Firmness (EXTEM-/FIBTEM-MCF) were higher in COVID-19 patients compared with in healthy controls (p < 0.001) and higher in severely ill patients compared with in patients at regular wards (p < 0.05). Our results suggest that hypercoagulopathy is present early in patients with mild to moderate disease, and more pronounced in severe COVID-19 pneumonia. Non-O blood types were not overrepresented in COVID-19 positive patients. ROTEM variables showed hypercoagulopathy at admission and this pattern was more pronounced in patients with increased disease severity. If this feature is to be used to predict the risk of thromboembolic complications further studies are warranted.

Download Full-text

Reference ranges of rotational thromboelastometry parameters in pregnant women and puerperas: a single-center randomized trial

Тромбоз, гемостаз и реология ◽

10.25555/thr.2020.3.0928 ◽

2020 ◽

Author(s):

Ю.С. Распопин ◽

В.В. Потылицина ◽

А.И. Грицан ◽

А.В. Ковалев ◽

И.А. Ольховский

Keyword(s):

Pregnant Women ◽

Postpartum Period ◽

Reference Intervals ◽

Reference Ranges ◽

Rotational Thromboelastometry ◽

Early Postpartum Period ◽

Krasnoyarsk Region ◽

Early Postpartum ◽

Coagulation Tests ◽

Obstetric Surgery

Введение: В последнее время стали востребованы интегральные тесты оценки системы гемостаза у женщин во время беременности, а также во время акушерских операций, связанных с кровотечением. В нашей стране отсутствуют работы по определению популяционных норм ротационной тромбоэластометрии (РОТЕМ) у беременных, рожениц и родильниц. Цель исследования: определить пределы референсных интервалов показателей РОТЕМ во время физиологически протекающей беременности и в раннем послеродовом периоде и провести корреляционный анализ со стандартными показателями коагулограммы. Материалы и методы: Обследовано 229 женщин Красноярского края, которые были поделены на 5 групп: небеременные (контроль), беременные II и III триместров, женщины раннего послеродового периода после операции кесарева сечения и естественных родов. Все женщины были сопоставимы по возрасту, индексу массы тела, сопутствующей патологии. Референсные интервалы рассчитывали либо через среднее и стандартное отклонение (для нормального распределения), либо через медиану и 2,5 и 97,5% перцентили (для ненормального распределения). Результаты: В процессе исследования подтвердилось, что во время беременности и в раннем послеродовом периоде происходят изменения в системе гемостаза в сторону гиперкоагуляции. Показатели ROTЕM у женщин в III триместре беременности и раннем послеродовом периоде существенно отличаются от показателей небеременных в популяции. У женщин после родов вне зависимости от способа родоразрешения различий между параметрами ROTЕM не установлено. Корреляция между параметрами ROTЕM и традиционными лабораторными тестами коагуляции выявила взаимосвязь между амплитудой плотности сгустка в тесте FIBTEM и уровнем фибриногена по Клаусу. Заключение: Представлены референсные интервалы параметров РОТЕМ у женщин Красноярского края. Найдена корреляция между параметрами РОТЭМ и уровнем фибриногена. Background: Recently, integral tests for hemostasis assessment in pregnant women as well as during obstetric surgery associated with bleeding have become popular. In our country, there are no studies of population norms for rotational thromboelastometry (ROTEM) in pregnant women, parturients and puerperants. Objectives: to identify reference intervals limits for ROTEM parameters during physiological pregnancy and in early postpartum period and to carry out correlation analysis with standard coagulogram parameters. Patients/Methods: We examined 229 women in Krasnoyarsk region; they were divided into 5 groups: nonpregnant (control), pregnant women in II and III trimesters, women in early postpartum period after cesarean section and after vaginal delivery. All women were comparable in age, body mass index, and concomitant pathology. Reference intervals were calculated either as the mean and standard deviation (for normal distribution), or as the median and 2.5 and 97.5% percentiles (for abnormal distribution). Results: The study confirmed hemostasis hypercoagulation changes during pregnancy and in early postpartum period. ROTEM parameters in women in III trimester of pregnancy and in early postpartum period differ significantly from those in non-pregnant women. Differences between ROTEM parameters in puerperants, regardless of the delivery method, not found. The correlation between ROTEM parameters and traditional laboratory coagulation tests revealed a relationship between clot density amplitude in FIBTEM test and Klaus fi brinogen level. Conclusions: Reference intervals of ROTEM parameters in women of Krasnoyarsk region are presented. A correlation was found between ROTEM parameters and fibrinogen level

Download Full-text

Hemostasis assessment with standard coagulation tests and rotational thromboelastometry (ROTEM) during therapeutic plasma exchange treatment

Clinical Nephrology ◽

10.5414/cnp96s17 ◽

2021 ◽

Vol 96 (Suppl 1) ◽

pp. 96-100

Author(s):

Matej Zrimšek ◽

Andreja Marn Pernat

Keyword(s):

Plasma Exchange ◽

Therapeutic Plasma Exchange ◽

Rotational Thromboelastometry ◽

Coagulation Tests

Download Full-text

Rotational thromboelastometry and standard coagulation tests for live liver donors

Clinical Transplantation ◽

10.1111/ctr.12067 ◽

2013 ◽

Vol 27 (2) ◽

pp. E101-E108 ◽

Cited By ~ 11

Author(s):

Maged Mohammed ◽

Nirmeen Fayed ◽

Ashraf Hassanen ◽

Fatma Ahmed ◽

Wessam Mourad ◽

...

Keyword(s):

Rotational Thromboelastometry ◽

Coagulation Tests ◽

Liver Donors

Download Full-text

Whole Blood Coagulation Tests are not Equally able to Detect Haemostatic Prothrombotic Alterations in Patients with Liver Cirrhosis and Hepatocellular Carcinoma: Rotational Thromboelastometry versus Thrombingeneration Test

Journal of Hepatology ◽

10.1016/s0168-8278(16)00256-7 ◽

2016 ◽

Vol 64 (2) ◽

pp. S246

Author(s):

A. Zanetto ◽

A. Ferrarese ◽

E. Nadal ◽

I. Bortoluzzi ◽

E. Campello ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Cirrhosis ◽

Blood Coagulation ◽

Whole Blood ◽

Blood Coagulation Tests ◽

Rotational Thromboelastometry ◽

Coagulation Tests

Download Full-text

Coagulation Status in Dogs Naturally Infected with Angiostrongylus vasorum

Pathogens ◽

10.3390/pathogens10091077 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1077

Author(s):

Nadja E. Sigrist ◽

Lucienne Tritten ◽

Claudia Kümmerle-Fraune ◽

Natalie Hofer-Inteeworn ◽

Rahel Jud Schefer ◽

...

Keyword(s):

Clinical Signs ◽

Angiostrongylus Vasorum ◽

Clinicopathological Parameters ◽

Fibrinogen Concentration ◽

Tem Analysis ◽

Coagulation Tests ◽

Plasmatic Coagulation ◽

Coagulation Status ◽

Healthy Dogs ◽

And Control

Angiostrongylus vasorum infection has been associated with coagulopathies including hyperfibrinolysis. We compared coagulation status including thromboelastometry (ROTEM) parameters in dogs naturally infected with A. vasorum versus healthy dogs to determine clinicopathological parameters associated with bleeding, hypocoagulopathy, and hyperfibrinolysis. Clinical signs, white blood cell count, platelet count, hematocrit, plasmatic coagulation tests (PT, aPTT, fibrinogen concentration), D-dimer, and ROTEM S parameters (Ex-tem, In-tem, Fib-tem, Ap-tem) were analysed and compared between bleeding, nonbleeding, and control dogs and between hypo- and normocoagulable animals. Clinical signs of bleeding were present in 6/9 (67%) hypocoagulable and 1/9 (11%) normocoagulable dogs. PT, fibrinogen concentration, and several ROTEM parameters were significantly different between hypocoagulable and normocoagulabe A. vasorum infected dogs. Hyperfibrinolysis was identified in 44% of infected dogs and was significantly more common in bleeding and hypocoagulable dogs. Hyperfibrinolysis was significantly associated with low MCFFib-tem but not with low fibrinogen concentration or increased D-dimers. CFTEx-tem > 248 swas 100% sensitive and 89% specific to predict hyperfibrinolysis. Hyperfibrinolysis, hypocoagulability and bleeding are common in A. vasorum infected dogs. Only Ex-tem and Fib-tem parameters and potentially PT were associated with bleeding or hypocoagulability. Ex-tem analysis enables detection of bleeding, hypocoagulability and hyperfibrinolysis within minutes.

Download Full-text

The Utilization of Viscoelastic Testing to Guide Blood Component Therapy and Adjunctive Hemostatic Therapy for Postpartum Hemorrhage: A Narrative Review

Current Opinion in Gynecology and Obstetrics ◽

10.18314/cogo.v2i1.1837 ◽

2019 ◽

pp. 272-286

Author(s):

Baumgartner S ◽

Shariff F ◽

Vande Lune SA ◽

Zackariya N ◽

Grisoli A ◽

...

Keyword(s):

Postpartum Hemorrhage ◽

Point Of Care ◽

Narrative Review ◽

Blood Component ◽

Clinical Parameters ◽

Rotational Thromboelastometry ◽

Coagulation Tests ◽

Blood Component Therapy ◽

History Of ◽

Hemostatic Therapy

This narrative review discusses the history of the pathophysiologic principles and utilization of point-of-care (POC) viscoelastic tests (VETs) in the definition and treatment of postpartum hemorrhage (PPH). This paper addresses the epidemiology of PPH, describes the hemostatic changes that occur in pregnancy and in PPH, and demonstrates the utilization of viscoelastic testing in the identification and treatment of patients with PPH. Additionally, a description of rotational thromboelastometry (ROTEM) and thromboelastography (TEG), the two most commonly used VETs, is detailed in this paper. VETs have only recently been used to guide blood component therapy (BCT) in trauma in the last decade. The recent increased utilization of VETs to guide BCT in PPH is following a similar trend with a delay of ten years. In a similar fashion to the trauma literature, which expanded greatly within this last decade, the literature concerning the use of VETs in PPH has also increased in the last few years. However, because of differing pathophysiologies associated with the coagulopathy of PPH verses traumatic-induced coagulopathy (TIC), utilization of VETs has been more refined and focused on the VETs’ capacity to determine low fibrinogen and to guide the utilization of blood components and prohemostatic agents. The identification and treatment of PPH depends on clinical parameters, conventional coagulation tests (CCTs) including Clauss fibrinogen, and VETs. Successful treatment of PPH will no doubt include utilization of all three strategies with an increasing utilization of VETs in the future.

Download Full-text

The influence of excipients commonly used in freeze drying on whole blood coagulation dynamics assessed by rotational thromboelastometry

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2014-1046 ◽

2015 ◽

Vol 53 (10) ◽

Cited By ~ 2

Author(s):

Matthias Erber ◽

Geoffrey Lee

Keyword(s):

Blood Coagulation ◽

Platelet Function ◽

Active Compound ◽

Whole Blood ◽

Freeze Drying ◽

Daily Basis ◽

Bulking Agents ◽

Rotational Thromboelastometry ◽

Plasmatic Coagulation ◽

Coagulation Dynamics

AbstractLyophilized reagents are used on a daily basis in coagulation diagnostics. They often contain a number of excipients in addition to the active compound. Some of these excipients may, however, influence coagulation dynamics.Besides from plasmatic coagulation bulking agents may influence platelet properties. We therefore studied the influence of a variety of bulking agents (glycine, mannitol, sucrose and trehalose) as well as a surfactant (TweenBoth disaccharides as well as TweenWhile the influence observed for glycine may be due to fibrinogen precipitation, the mechanism of mannitol appears to be more complex as platelet function as well as fibrin-based clot formation are influenced. This study therefore demonstrates the necessity to check for coagulation impairment due to compounds contained in lyophilized reagents.

Download Full-text

The Effect of Platelet -, and Leukocyte Count on the Thrombelastograph® (TEG) Parameters.

Blood ◽

10.1182/blood.v104.11.3971.3971 ◽

2004 ◽

Vol 104 (11) ◽

pp. 3971-3971

Author(s):

W.W.H. Roeloffzen ◽

J.C. Kluin-Nelemans ◽

Joost de Wolf

Keyword(s):

Platelet Count ◽

Point Of Care ◽

Maximum Amplitude ◽

Multiple Regression Model ◽

Clot Strength ◽

Normal Limits ◽

Coagulation Tests ◽

Plasmatic Coagulation ◽

Sensitivity Specificity ◽

Normal Controls

Abstract Background. The TEG is used in situations were point of care testing of hemostasis is desired, although its value is still controversially because of insufficient test validation. The main parameters of the TEG are (a) the reaction time (R), the time until the initial fibrin formation and comparable with the coagulation times PT and APTT; (b) clotting time (K), the time until a fixed level of clot firmness is reached; (c) the angle (α) is closely related to K and measures the rapidity of fibrin build up and gives information about the clot strength; R, K and α are prolonged by anticoagulants and factor deficiencies; (d) maximum amplitude (MA) is a measurement of maximum strength or stiffness of the developed clot; it is especially influenced by platelets and fibrin. Methods. We performed a multivariate analysis using the Cox multiple-regression model to study the effects of Leukocytes, Hb, and platelet count on the TEG parameters. Results. Ninety native whole blood samples from 19 patients undergoing consolidation chemotherapy were studied; in the post chemotherapy phase in which platelets decreased from normal to < 10 x 109/l samples were taken; in all these cases PT, APTT and Fibrinogen were within normal limits. Platelets significantly influenced all parameters: R (p<0.001, r=−0.5), K (p<0.001, r=−0.7), α (p<0.001, r=+0.7), MA (p<0.001, r=+0.6) whereas Leukocytes influenced MA as well (p<0.001, r=0.3). In normal controls K is 9 ± 3 min (n=110), in patients with platelet count 50–100, 25–50 and <25 x 109/l K was resp. 17 ± 9, 30 ± 13 and 46 ± 10 min. In normal controls MA was 46 ± 7 mm, in patients MA became significant smaller with platelets < 25 x 109/l: 30 ± 5 mm. In patients with leukocytes ranging from 0–0.1, 0.1–1.0, 1.0–3.5 and > 3.5 x 109/l the MA was resp. 44 ± 14, 49 ± 15, 54 ± 9, and 58 ± 8 mm. As the MA is considered the parameter most influenced by platelet count, we calculated the sensitivity, specificity, pos and neg predictive value of MA to detect a platelet count less then 50 x 109/l, they were resp. 35%, 100%, 100% and 73%. Conclusion. Firstly, platelet count not only influences MA but also the coagulation parameters R, K and α; besides leukocytes influences the clot strength; this is in agreement with the new conceptual cell based model of hemostasis; secondly, the TEG should be considered as additive to platelet count and plasmatic coagulation tests and not as a replacement.

Download Full-text