title: Rotation thromboelastometry detects thrombocytopenia and hypofibrinogenaemia during orthotopic liver transplantation.
abstract: BACKGROUND
  Orthotopic liver transplantation can be associated with haemorrhage, particularly in patients with severe liver dysfunction. We assessed the value of rotation thromboelastometry (ROTEM) to monitor coagulation in the operating theatre, its correlation with routine laboratory findings, and its ability to guide platelet (Plt) and fibrinogen (Fg) transfusion.
  
  
  METHODS
  Twenty-three patients were included in this prospective observational study. Laboratory tests and ROTEM tests (EXTEM, INTEM, FIBTEM, and APTEM) were performed six times during the procedure. Correlations between laboratory findings and ROTEM parameters were sought. Thresholds for ROTEM parameters were determined with receiver-operating characteristic (ROC) curve analysis according to Plt count and Fg levels.
  
  
  RESULTS
  Clot amplitude at 10 min (A10) of EXTEM was well correlated with Plt count and Fg levels (R(2)=0.46 and 0.52, respectively, P<0.0001). FIBTEM A10 was correlated with Fg (R(2)=0.55, P<0.0001). ROC analysis showed that EXTEM A10 with a threshold of 29 mm predicted thrombocytopenia with a sensitivity of 79% and a specificity of 60%, and a threshold of 26 mm predicted hypofibrinogenaemia with a sensitivity of 83% and a specificity of 75%.
  
  
  CONCLUSIONS
  ROTEM is useful for the global assessment of coagulation in the operating theatre. EXTEM was the most informative for assessing the whole coagulation process and A10 showed value in guiding Plt and Fg transfusion.
authors.affiliation: Centre Hospitalier Universitaire de Bordeaux, France. stephanie.roullet@chu-bordeaux.fr
authors.forename: S
authors.initials: S
authors.lastname: Roullet
authors.forename: J
authors.initials: J
authors.lastname: Pillot
authors.forename: G
authors.initials: G
authors.lastname: Freyburger
authors.forename: M
authors.initials: M
authors.lastname: Biais
authors.forename: A
authors.initials: A
authors.lastname: Quinart
authors.forename: A
authors.initials: A
authors.lastname: Rault
authors.forename: P
authors.initials: P
authors.lastname: Revel
authors.forename: F
authors.initials: F
authors.lastname: Sztark
mesh_terms: D000347:Afibrinogenemia / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013916:Thrombelastography / Q000379:methods*; D013921:Thrombocytopenia / Q000175:diagnosis* / Q000209:etiology