title: Rapid and correct prediction of thrombocytopenia and hypofibrinogenemia with rotational thromboelastometry in cardiac surgery.
abstract: OBJECTIVE
  In the present study, the authors have investigated whether rotational thromboelastometry (ROTEM) could predict thrombocytopenia and hypofibrinogenemia in cardiac surgery using the clot amplitude after 5 minutes (A5). Another parameter, PLTEM, in which the contribution of fibrinogen is eliminated by subtracting a fibrin-specific ROTEM test (FIBTEM) from an extrinsically-activated ROTEM test (EXTEM), was investigated. Furthermore, the turnaround time of ROTEM was compared to conventional laboratory tests.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Single academic medical center.
  
  
  METHODS
  Ninety-seven patients undergoing cardiac surgery between July 2011 until August 2012.
  
  
  METHODS
  The correlations between EXTEM/FIBTEM A5, A10, and maximal clot formation (MCF), EXTEM/PLTEM (A5/A10, and MCF) and platelet count, and FIBTEM (A5/A10, and MCF) and fibrinogen were evaluated using the Pearson's correlation coefficient and receiver-operating characteristic curves. Turnaround times of ROTEM tests and conventional laboratory tests were assessed in the central laboratory.
  
  
  RESULTS
  EXTEM A5 and FIBTEM A5 showed an excellent correlation with A10 (R:0.99/1.00) and MCF (R:0.97/0.99). The correlation between EXTEM A5 and platelet count (R:0.74) was comparable with the correlation of A10 (R:0.73) and MCF (R:0.70) with platelet count. FIBTEM A5 predicted fibrinogen levels (R:0.87) as well as A10 (R:0.86) and MCF (R:0.87). PLTEM A5 (R:0.85) correlated better with platelet count than EXTEM A5 (R:0.74; p = 0.04) and showed significantly better area under the curve values than EXTEM for predicting thrombocytopenia (A5 p = 0.012, A10 p = 0.019). Turnaround time for ROTEM tests, 12 minutes, was comparable with emergency requests for platelet count, 13 minutes, and shorter than emergency requests for fibrinogen levels, 37 minutes.
  
  
  CONCLUSIONS
  Implementation of PLTEM and FIBTEM A5 in ROTEM-guided transfusion protocols may improve transfusion management.
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands. Electronic address: r.h.oldeengberink@amc.uva.nl.
authors.forename: Rik H G
authors.initials: RH
authors.lastname: Olde Engberink
authors.affiliation: Department of Anesthesiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Gerhardus J A J M
authors.initials: GJ
authors.lastname: Kuiper
authors.affiliation: Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Rick J H
authors.initials: RJ
authors.lastname: Wetzels
authors.affiliation: Department of Epidemiology and Statistics, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Patty J
authors.initials: PJ
authors.lastname: Nelemans
authors.affiliation: Department of Anesthesiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Lance
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Erik A M
authors.initials: EA
authors.lastname: Beckers
authors.affiliation: Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Yvonne M C
authors.initials: YM
authors.lastname: Henskens
mesh_terms: D000347:Afibrinogenemia / Q000175:diagnosis*; D000368:Aged; D019540:Area Under Curve; D001778:Blood Coagulation Disorders / Q000097:blood / Q000175:diagnosis; D001803:Blood Transfusion / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D013916:Thrombelastography / Q000379:methods*; D013921:Thrombocytopenia / Q000097:blood / Q000175:diagnosis*
chemical_list: D006454:Hemoglobins
keywords: ROTEM; cardiac surgery; hypofibrinogenemia; laboratory time; thrombocytopenia; thromboelastometry