title: A prospective diagnostic accuracy study evaluating rotational thromboelastometry and thromboelastography in 100 patients with von Willebrand disease.
abstract: BACKGROUND
  Rotational thromboelastometry (ROTEM®) and thromboelastography (TEG®) are increasingly used in the perioperative and emergency assessment of bleeding tendencies. The diagnostic value of ROTEM and TEG for von Willebrand disease (VWD) remains to be established.
  
  
  OBJECTIVE
  To investigate whether ROTEM and TEG can discriminate patients with VWD from healthy controls.
  
  
  METHODS
  Rotational thromboelastometry and TEG whole blood coagulation profiles were compared between VWD patients (n = 100) and healthy controls (n = 89). Measures of diagnostic accuracy were calculated, including sensitivity, specificity and receiver operating characteristic (ROC) curve.
  
  
  RESULTS
  Prolonged TEG R-time had a positive and negative predictive value (PPV, NPV) of 0.84 and 0.68 respectively. TEG clotting index (CI) had a PPV of 1.00 and an NPV of 0.60. Both R-time and CI had a high specificity and accurately discriminated VWD patients from healthy controls, with an ROC area under the curve of 0.85 and 0.99 respectively. In multivariate analysis, low FVIII levels, but not von Willebrand factor (VWF) antigen or activity, determined hypocoagulable TEG R (R2= 0.35) and CI levels (R2= 0.51). The ROTEM coagulation profiles of VWD patients did not differ from healthy controls.
  
  
  CONCLUSIONS
  Thromboelastography R and CI accurately discriminated VWD patients from healthy controls, partly through the detection of low FVIII levels. The test's performance may be improved through adjustment of the test thresholds to a local reference population. Both intrinsic pathway-activated (INTEM) and tissue factor pathway-activated (EXTEM) ROTEM were of limited diagnostic value in VWD.
authors: Division of Haematology, Department of Medicine, Coagulation Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.|University Medical Center Utrecht, Utrecht, The Netherlands.
authors: D E
authors: DE
authors: Schmidt
authors: Division of Haematology, Department of Medicine, Coagulation Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors: A
authors: A
authors: Majeed
authors: Division of Haematology, Department of Medicine, Coagulation Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors: M
authors: M
authors: Bruzelius
authors: Division of Haematology, Department of Medicine, Coagulation Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors: J
authors: J
authors: Odeberg
authors: Division of Haematology, Department of Medicine, Coagulation Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors: M
authors: M
authors: Holmström
authors: Division of Haematology, Department of Medicine, Coagulation Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors: A
authors: A
authors: Ågren
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013916:Thrombelastography / Q000379:methods*; D014842:von Willebrand Diseases / Q000175:diagnosis*
keywords: 
  ROTEM
  ; diagnosis; monitoring; thromboelastography; von Willebrand disease