title: Thromboelastometry analysis of thrombocytopenic dengue patients: a cross-sectional study.
abstract: Dengue virus infection (DVI) is a prevalent and potentially fatal viral disease associated with coagulopathy. So far, the coagulation profile of DVI patients with thrombocytopenia has not been assessed through a viscoelastic test such as rotational thromboelastometry. We aimed to describe the prevalence and characteristics of coagulation abnormalities in dengue fever outpatients with thrombocytopenia, addressed by both rotational thromboelastometry and conventional coagulation tests.
  
  
  
  This was a cross-sectional study conducted between April 6thand May 5th2015 in São Paulo, Brazil during a dengue outbreak. Thromboelastometry (ROTEM®) and the conventional coagulation tests prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), thrombin time (TT), platelet count and fibrinogen levels were performed in 53 patients with DVI and thrombocytopenia.
  
  
  
  Despite a median interquartile range (IQR) platelet count of 77 (63-88) x 109/L in DVI patients, conventional coagulation tests and plasma fibrinogen levels were within the normal range. Subjects demonstrated hypocoagulability in 71.7% (38/53) in INTEM and 54.7% (29/53) in EXTEM DVI patients. FIBTEM analyses detected only 5.7% (3/53) with hypocoagulability among this population. The median (IQR) clotting time (CT), clot formation time (CFT) and maximum clot firmness (MCF) on INTEM were, respectively, 177 (160-207) sec, 144 (108-178) sec and 48 (42-52) mm. On EXTEM, median (IQR) CT, CFT and MCF were, respectively, 69 (65-78) sec, 148 (126-198) sec and 49 (44-55) mm. Median (IQR) MCF on FIBTEM was 15 (13-18) mm.
  
  
  
  Thromboelastometry impairment is highly prevalent in DVI patients with thrombocytopenia, particularly in INTEM and EXTEM analyses, while standard coagulation tests are normal in this setting. Clinical implications remain to be established.
authors.affiliation: Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil. felipe.piza@einstein.br.
authors.forename: Felipe Maia de Toledo
authors.initials: FM
authors.lastname: Piza
authors.affiliation: Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.
authors.forename: Thiago Domingos
authors.initials: TD
authors.lastname: Corrêa
authors.affiliation: Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.
authors.forename: Alexandre Rodrigues
authors.initials: AR
authors.lastname: Marra
authors.affiliation: Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.
authors.forename: João Carlos Campos
authors.initials: JC
authors.lastname: Guerra
authors.affiliation: Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.|Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Roseny Dos Reis
authors.initials: RD
authors.lastname: Rodrigues
authors.affiliation: Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.
authors.forename: Andrea Aparecida Rocco
authors.initials: AA
authors.lastname: Villarinho
authors.affiliation: Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.
authors.forename: Valdir Fernandes
authors.initials: VF
authors.lastname: de Aranda
authors.affiliation: Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.
authors.forename: Sandra Christina Pereira Lima
authors.initials: SC
authors.lastname: Shiramizo
authors.affiliation: Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.
authors.forename: Maria Roza de Jesus
authors.initials: MR
authors.lastname: de Lima
authors.affiliation: Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Esper Georges
authors.initials: EG
authors.lastname: Kallas
authors.affiliation: Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Alexandre Biasi
authors.initials: AB
authors.lastname: Cavalcanti
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000097:blood* / Q000209:etiology; D001780:Blood Coagulation Tests; D001938:Brazil; D003430:Cross-Sectional Studies; D003715:Dengue / Q000097:blood* / Q000150:complications; D003716:Dengue Virus; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D011517:Prothrombin Time; D013916:Thrombelastography; D013918:Thrombin Time; D013921:Thrombocytopenia / Q000097:blood* / Q000209:etiology; D019851:Thrombophilia / Q000097:blood* / Q000209:etiology; D055815:Young Adult