Comparison of standard coagulation tests and rotational thromboelastometry for hemostatic system monitoring during orthotopic liver transplantation: Results from a pilot study

Introduction. During liver transplantation, continuous laboratory monitoring of complex changes of the hemostatic system is necessary. The aim of this study was to compare two methods of monitoring: standard coagulation tests and rotational thromboelastometry. Material and Methods. The study included 17 patients who had undergone orthotopic liver transplantation in the Clinical Centre of Vojvodina, Serbia in the period from June 2008 to October 2012. The coagulation parameters (platelet count, activated partial thromboplastin time, prothrombin time and fibrinogen level) were compared with the thromboelastometric parameters (coagulation time, clot formation time and maximal clot firmness). Results. The results showed a statistically significant correlation between the platelet count and maximum clot firmness of the intrinsically (r=0.51, p<0.001) and extrinsically activated thromboelastometric assays (r=0.64, p<0.001). The fibrinogen level and maximum clot firmness of the fibrinogen thromboelastometric test correlated significantly as well (r=0.44, p=0.002). No significant correlations were found among the activated partial thromboplastin time, prothrombin time, coagulation time and clot formation time. Conclusion. For an adequate perioperative monitoring of the dynamic intraoperative hemostatic changes and the optimal use of blood derivatives during liver transplantation, the combined application of standard coagulation tests and rotational thromboelastometry should be considered whenever possible. Science and Technological Development, Republic of Serbia

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Changes in Hematologic and Coagulation Profiles in Rabbits with Right-ventricle Pacing

Folia Medica ◽

10.1515/folmed-2016-0013 ◽

2016 ◽

Vol 58 (2) ◽

pp. 89-94

Author(s):

Ivana Uhrikova ◽

Milan Sepsi ◽

Jana Hlozkova ◽

Pavel Suchy ◽

Marta Kasajova ◽

...

Keyword(s):

Platelet Count ◽

Right Ventricle ◽

Fibrinogen Level ◽

Jugular Vein ◽

Leukocyte Count ◽

Cell Mass ◽

Activated Partial Thromboplastin Time ◽

Differential Leukocyte Count ◽

Coagulation Tests ◽

Pacemaker Placement

Abstract Objectives: The aim of this study was to evaluate changes in hematology and coagulation in rabbits with right-ventricle pacing without medication. Animals and methods: Blood was collected from ten non-anesthetized male rabbits from the jugular vein before and one month after pacemaker placement. Total erythrocyte, leukocyte and platelet count, hemoglobin, hematocrit and differential leukocyte count were done on automatic veterinary flow cytometry hematologic analyzer. Prothrombin time, activated partial thromboplastin time, fibrinogen level, D-dimers and kaolin-activated thromboelastography was measured from citrated blood. Results: We found an increase in red blood cell mass and decrease in platelet count, while coagulation tests did not diff er between samplings. Conclusion: Right-ventricle pacing seems to have no influence on hemostasis in rabbits.

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Screening coagulation tests in normal pregnancy

HEALTH OF WOMAN ◽

10.15574/hw.2020.150.58 ◽

2020 ◽

pp. 58-60

Author(s):

S.I. Zhuk ◽

◽

I.V. Us ◽

Keyword(s):

Pregnant Women ◽

Partial Thromboplastin Time ◽

Fibrinogen Level ◽

Normal Pregnancy ◽

Activated Partial Thromboplastin Time ◽

Control Group ◽

Term Pregnancy ◽

Hemostatic System ◽

Keywords Screening ◽

Coagulation Tests

The objective: to evaluate the performance of screening coagulation tests in normal pregnancy. Materials and methods. A study of screening coagulation tests was conducted with the participation of 124 patients with normal pregnancy in terms of 12–14, 20–22, 28–30 and 37–40 weeks of gestation. The control group consisted of 82 patients who were at the pregravid stage of pregnancy planning. Coagulation tests were determined on a HELENA 2000 coagulometer. Namely, the activated partial thromboplastin time, the percentage of prothrombin by Quick and fibrinogen were examined. Results. During normal pregnancy, a dynamic, statistically significant increase in plasma fibrinogen level was determined. This indicator during full-term pregnancy differed from that of non-pregnant women by 1.8 times. During all normal pregnancies, there was no statistically significant dynamics of the activated partial thromboplastin time and the percentage of prothrombin by Quick, but there was a tendency towards these indicators increase in coagulation potential with an increase in the gestation term. Conclusion. When assessing a screening coagulation tests, pregnancy term should be taken into account first of all, rather than comparing the obtained values with reference indices for non-pregnant women. Keywords: screening coagulation tests, hemostatic system, fibrinogen level, prothrombin percentage by Quick, activated partial thromboplastin time.

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Influence of Acute Normobaric Hypoxia on Hemostasis in Volunteers with and without Acute Mountain Sickness

BioMed Research International ◽

10.1155/2015/593938 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 7

Author(s):

Marc Schaber ◽

Veronika Leichtfried ◽

Dietmar Fries ◽

Maria Wille ◽

Hannes Gatterer ◽

...

Keyword(s):

Acute Mountain Sickness ◽

Activated Partial Thromboplastin Time ◽

Reference Ranges ◽

Simulated Altitude ◽

Coagulation Time ◽

Hemostatic System ◽

Mountain Sickness ◽

Healthy Participants ◽

Generation Test ◽

Maximum Clot Firmness

Introduction. The aim of the present study was to investigate whether a 12-hour exposure in a normobaric hypoxic chamber would induce changes in the hemostatic system and a procoagulant state in volunteers suffering from acute mountain sickness (AMS) and healthy controls.Materials and Methods. 37 healthy participants were passively exposed to 12.6% FiO2(simulated altitude hypoxia of 4,500 m). AMS development was investigated by the Lake Louise Score (LLS). Prothrombin time, activated partial thromboplastin time, fibrinogen, and platelet count were measured and specific methods (i.e., thromboelastometry and a thrombin generation test) were used.Results. AMS prevalence was 62.2% (LLS cut off of 3). For the whole group, paired samplet-tests showed significant increase in the maximal concentration of generated thrombin. ROTEM measurements revealed a significant shortening of coagulation time and an increase of maximal clot firmness (InTEM test). A significant increase in maximum clot firmness could be shown (FibTEM test).Conclusions. All significant changes in coagulation parameters after exposure remained within normal reference ranges. No differences with regard to measured parameters of the hemostatic system between AMS-positive and -negative subjects were observed. Therefore, the hypothesis of the acute activation of coagulation by hypoxia can be rejected.

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Prevalence of Acute Traumatic Coagulopathy in Acutely Traumatized Dogs and Association with Clinical and Laboratory Parameters at Presentation

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0040-1721707 ◽

2021 ◽

Author(s):

Yaiza Herrero ◽

Rahel Jud Schefer ◽

Benjamin M. Muri ◽

Nadja E. Sigrist

Keyword(s):

Clotting Time ◽

Acute Traumatic Coagulopathy ◽

Rotational Thromboelastometry ◽

Clot Strength ◽

Laboratory Parameters ◽

Coagulation Abnormalities ◽

Trauma Triage ◽

Clot Formation Time ◽

Maximum Clot Firmness ◽

Traumatic Coagulopathy

Abstract Objective The aim of this study was to determine the prevalence of acute traumatic coagulopathy (ATC) and identify associated clinical and laboratory parameters including rotational thromboelastometry. Study Design Dogs presenting within 6 hours after trauma were allocated to the ATC or non-ATC group based on thromboelastometry analysis (ex-tem S, in-tem S, fib-tem S). ATC was defined as ≥2 hypocoagulable parameters in 1 profile and ≥ 1 hypocoagulable parameter in an additional profile. Parameters used were ex-tem and in-tem clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), maximum lysis and fib-tem MCF. Clinical and laboratory parameters at presentation, animal trauma triage (ATT) score, transfusion requirement and outcome were compared. Logistic regression was used to identify independent factors associated with ATC. Results Eleven of 33 dogs presented with ATC and showed ex-tem CT and CFT prolongation and reduced MCF amplitude in all profiles (all p < 0.001). pH (p = 0.043) and potassium concentration (p = 0.022) were significantly lower and bleeding (p = 0.027) and plasma transfusions (p = 0.001) more common in dogs with ATC. Time after trauma (p = 0.040) and Animal Trauma Triage score (p = 0.038, including haematocrit as confounding factor) were associated with the presence of ATC. Conclusion Acute traumatic coagulopathy is more common in traumatized dogs than previously reported. Acute traumatic coagulopathy was associated with acidosis, Animal trauma triage score, time after trauma and higher transfusion needs. Coagulation abnormalities include ex-tem CT and CFT prolongations and decreased clot strength.

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Thromboelastometry in Neonates with Respiratory Distress Syndrome: A Pilot Study

Diagnostics ◽

10.3390/diagnostics11111995 ◽

2021 ◽

Vol 11 (11) ◽

pp. 1995

Author(s):

Georgios N. Katsaras ◽

Rozeta Sokou ◽

Andreas G. Tsantes ◽

Aikaterini Konstantinidi ◽

Dimitra Gialamprinou ◽

...

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Multivariable Logistic Regression Analysis ◽

Extrinsic Pathway ◽

Term Neonates ◽

Rotational Thromboelastometry ◽

Significant Prolongation ◽

Clot Formation Time ◽

Maximum Clot Firmness

Background: Although respiratory distress syndrome (RDS) constitutes a postnatal risk factor for bleeding and thromboembolic events in neonates, few studies have addressed this issue. We aimed to evaluate the hemostatic profile of neonates with RDS using rotational thromboelastometry (ROTEM). Methods: An observational study was conducted from November 2018 to November 2020 in the NICU of General Hospital of Nikaia “Aghios Panteleimon”. Preterm and term neonates with RDS hospitalized in the NICU were included and EXTEM (tissue factor-triggered extrinsic pathway), INTEM (ellagic acid activated intrinsic pathway), and FIBTEM (with platelet inhibitor cytochalasin D) assays were performed at the onset of the disease. Results: A hypocoagulable profile was noted in neonates with RDS compared to controls, expressed as significant prolongation of EXTEM CT (clotting time) and CFT (clot formation time), lower EXTEM A10 (amplitude at 10 min), MCF (maximum clot firmness), and LI60 (lysis index). Furthermore, prolongation of INTEM CFT and FIBTEM CT, and decreased INTEM and FIBTEM A10 and MCF were found in neonates with RDS. Multivariable logistic regression analysis showed that RDS is an independent factor for the recorded alterations in ROTEM variables. Conclusions: RDS is associated with a hypocoagulable profile and greater hyperfibrinolytic potential compared to healthy neonates.

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Can RoTEM®analysis be applied for haemostatic monitoring in paediatric congenital heart surgery?

Cardiology in the Young ◽

10.1017/s1047951111000758 ◽

2011 ◽

Vol 21 (6) ◽

pp. 684-691 ◽

Cited By ~ 22

Author(s):

Jo Bønding Andreasen ◽

Anne-Mette Hvas ◽

Kirsten Christiansen ◽

Hanne Berg Ravn

Keyword(s):

Cardiac Surgery ◽

Platelet Count ◽

Prothrombin Time ◽

Partial Thromboplastin Time ◽

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Activated Partial Thromboplastin Time ◽

Clotting Time ◽

Coagulation Tests

AbstractBackgroundSuccessful management of bleeding disorders after congenital heart surgery requires detection of specific coagulation disturbances. Whole-blood rotation thromboelastometry (RoTEM®) provides continuous qualitative haemostatic profiles, and the technique has shown promising results in adult cardiac surgery.SettingTo compare the performance of RoTEM®with that of conventional coagulation tests in children, we conducted a descriptive study in children undergoing congenital cardiac surgery. For that purpose, 60 children were enrolled and had blood samples taken before, immediately after, and 1 day after surgery. Conventional coagulation tests included: activated partial thromboplastin time, prothrombin time, fibrinogen, fibrin D-dimer, thrombin clotting time, factor XIII, and platelet count.ResultsPost-surgical haemostatic impairment was present to some degree in all children, as seen by pronounced changes in activated partial thromboplastin time, prothrombin time, thrombin clotting time, and platelet count, as well as RoTEM®analysis. RoTEM®showed marked changes in clotting time – prolonged by 7–18% – clot formation time – prolonged by 46–71% – maximum clot firmness – reduced by 10–19%, and maximum velocity – reduced by 29–39%. Comparison of the two techniques showed that conventional coagulation tests and RoTEM®performed equally well with regard to negative predictive values for excessive post-operative drain production – more than 20 millilitres per kilogram per 24 hours after surgery – with an area under the curve of approximately 0.65.ConclusionRoTEM®can detect haemostatic impairments in children undergoing cardiac surgery and the method should be considered as a supplement in the perioperative care of the children where targeted transfusion therapy is necessary to avoid volume overload.

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Correlation of Dengue Warning Signs during Febrile Phase with Rotational Thromboelastometry, Cortisol and Feritin

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19020807 ◽

2022 ◽

Vol 19 (2) ◽

pp. 807

Author(s):

Syarifah Syahirah Syed Abas ◽

Noralisa Abdul Karim ◽

Petrick Periyasamy ◽

Nurasyikin Yusof ◽

Shamsul Azhar Shah ◽

...

Keyword(s):

Platelet Count ◽

Platelet Function ◽

Warning Signs ◽

Clotting Time ◽

Rotational Thromboelastometry ◽

Potential Marker ◽

Kinetics Of ◽

Platelet Functions ◽

Maximum Clot Firmness

Dengue mortality remains high despite monitoring against warning signs (WS). The associations of WS at febrile phase (FP) and hemorrhage at defervescence with the levels and kinetics of ROTEM, platelet count, cortisol, and ferritin were analyzed. Patients with confirmed dengue serology and WS in two centers were screened (n = 275) and 62 eligible patients were recruited prospectively over 9 months. “Vomiting” was the commonest WS (62.9%), with shortened clotting time (CT) INTEM (p = 0.01). “Hematocrit increase” showed significant prolonged CT INTEM, EXTEM, and FIBTEM (p < 0.05). “Platelet decrease” showed reduced platelet function and reduced clot amplitude at 10 min (A10) and maximum clot firmness (MCF) in INTEM and EXTEM (p < 0.001). The kinetics were reduced in platelet count, CT EXTEM, and cortisol (p < 0.05) but increased in CT INTEM (p = 0.03). At FP, “vomiting”, “hematocrit increase”, and “platelet decrease” demonstrated impaired CT, clot strengths A10/MCF and platelet functions. Majority (60/62, 96.7%) had non-severe outcomes, consistent with increase in cortisol kinetics. In conclusion, “vomiting”, “hematocrit increase” and “platelet decrease” at FP correlated with ROTEM. No conclusion could be made further regarding ferritin and cortisol. Larger study is required to study “hematocrit increase” with ROTEM as a potential marker for hemorrhage.

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Rotational thromboelastometry results are associated with care level in COVID-19

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-020-02312-3 ◽

2020 ◽

Cited By ~ 1

Author(s):

Lou M. Almskog ◽

Agneta Wikman ◽

Jonas Svensson ◽

Michael Wanecek ◽

Matteo Bottai ◽

...

Keyword(s):

Disease Severity ◽

Blood Type ◽

Care Level ◽

Rotational Thromboelastometry ◽

Moderate Disease ◽

High Prevalence ◽

Coagulation Tests ◽

Ventilation Support ◽

Level 1 ◽

Maximum Clot Firmness

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.

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Using Rotational Thromboelastometry to Identify Early Allograft Dysfunction after Living Donor Liver Transplantation

Journal of Clinical Medicine ◽

10.3390/jcm10153401 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3401

Author(s):

Chen-Fang Lee ◽

Hao-Chien Hung ◽

Wei-Chen Lee

Keyword(s):

Liver Transplantation ◽

Negative Predictive Value ◽

Predictive Value ◽

Living Donor ◽

Living Donor Liver Transplantation ◽

Donor Liver ◽

Rotational Thromboelastometry ◽

Donor Liver Transplantation ◽

Early Allograft Dysfunction ◽

Maximum Clot Firmness

Background: Diagnostic tests for early allograft dysfunction (EAD) after living donor liver transplantation (LDLT) vary widely. We aimed to evaluate the predictive value of rotational thromboelastometry (ROTEM)-derived parameters in EAD. Materials and Methods: A total of 121 patients were reviewed. The definition of EAD proposed by Olthoff et al. included the presence of any of the following at postoperative day 7: bilirubin level ≥ 10 mg/dL, INR ≥ 1.6, or serum AST or ALT levels > 2000 IU/L. All patients underwent ROTEM assay, which consisted of an extrinsically activated thromboelastometric test (EXTEM) before and 24 h after LDLT. Results: The 1-year/2-year OS were 68.%8/64.5% and 94.4%/90.8% for the EAD and non-EAD groups, respectively (p = 0.001). Two independent risks were identified for EAD, the postoperative clotting time (CT, p = 0.026) and time to maximum clot firmness (maximum clot firmness (MCF)-t, p = 0.009) on the EXTEM. CT yielded a specificity of 82.0% and negative predictive value of 83.0%, and MCF-t displayed a specificity of 76.4% and negative predictive value of 81.9% in diagnosing EAD. The use of the 24 h post-LDLT ROTEM increased the effectiveness of predicting overall survival (OS) compared to using the Olthoff’s EAD criteria alone (p < 0.001). Conclusion: We conclude that CT and MCF on EXTEM were independent predictors of EAD. The 24 h post-LDLT ROTEM can be used with conventional laboratory tests to diagnose EAD. It increases the effectiveness of predicting OS.

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Hemostatic Abnormality and Associated Factors in Diabetic Patients at Jimma University Specialized Hospital, Jimma, Southwest Ethiopia: A Comparative Cross-sectional Study

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v29i2.12 ◽

1970 ◽

Vol 29 (2) ◽

Author(s):

Debebe Asrat ◽

Girum Tesfaye ◽

Lealem Gedefaw ◽

Wondimagegn Addisu ◽

Tilahun Yemane

Keyword(s):

Platelet Count ◽

Associated Factors ◽

Fibrinogen Level ◽

Cross Sectional Study ◽

Diabetic Patients ◽

Sectional Study ◽

Cross Sectional ◽

Specialized Hospital ◽

Coagulation Tests ◽

Jimma University

BACKGROUND: Diabetes mellitus is a group of heterogeneous disorders of multiple etiologies characterized by chronic hyperglycemia resulting from defects in insulin secretion and/or insulin action. Diabetes mellitus has been reported to disturb normal hemostasis by various mechanisms. However, data on hemostasis of diabetic patients in the study area are lacking. This study was aimed at determining hemostatic profile and associated factors of hemostatic abnormality in diabetic patients.METHODS: A comparative cross-sectional study was conducted involving a total of 238 (119 diabetic and 119 apparently healthy) individuals who came to the chronic care clinic, Jimma University Specialized Hospital. Socio-demographic and clinical data were collected through a structured questionnaire. A blood sample of 10ml was collected in EDTA (4ml), citrate (3ml) and chemistry (3ml) tubes to do platelet count, coagulation tests, and glucose and lipid profile analysis, respectively. Descriptive statistics as well as the median (25th,75th) percentile and Mann Whitney U test were used during data analysis.RESULTS: The overall hemostatic abnormality in diabetes individuals was 58.8%. The median (25th, 75th percentile) prothrombin time for diabetic and non-diabetic subjects was (12.8, 15.6) vs. (12.8, 14.2), respectively, and the difference was not statistically significant (p>0.05). The median (25th, 75th percentile) activated partial thromboplastin time was significantly different between the two groups (p<0.0001); (24, 36.8) vs. (36, 39.6). The median (25th, 75th percentile) fibrinogen level was significantly different between the two groups (p<0.0001); (277, 462) vs. (243, 328). The median (25th, 75th percentile) platelet count was also significantly different between the two groups (p<0.0001); (146,248) vs. (190,319). All variables were not significantly associated with hemostatic abnormality in multivariate regression analysis.CONCLUSION: An overall hemostatic abnormality in diabetic patients was found to be high. The APTT and platelet count were lower in diabetic patients whilst the fibrinogen level was higher. Routine coagulation tests should be part of tests among diabetic patients. Advanced coagulation tests should also be considered to identify specific markers so as to pinpoint the particular problem.

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