Comparison of thromboelastometry (ROTEM®) with standard plasmatic coagulation testing in paediatric surgery
Comparison of thromboelastometry (ROTEM®) with standard plasmatic coagulation testing in paediatric surgery
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DOI：
10.1093/bja/aer342
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发表时间：
2012-01-01
影响因子：
9.8
通讯作者：
Weiss, M.
中科院分区：
文献类型：
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作者：
Haas, T.;Spielmann, N.;Weiss, M.
背景血栓弹性测定法（ROTEM（R））可能有助于在重大儿科手术中早期检测术中凝血障碍。这项观察性试验将该技术与标准凝血试验进行了比较。在接受择期大手术的儿童中采集术中血样。在每个时间点，由经过培训的医院实验室工作人员同时进行标准凝血试验[活化部分凝血活酶时间（aPTT）、凝血酶原时间（PT）和纤维蛋白原水平]和ROTEM（R）分析（InTEM、ExTEM和FibTEM）。共分析了50例受试者的288份血液样本。PT和aPTT分别与ExTEM凝血时间（CT）和InTEM CT相关性较差，而PT和aPTT与凝块形成时间相关性较好，纤维蛋白原水平与FibTEM测定相关性非常好（r = 0.882，P < 0.001）。值得注意的是，64%的PT和94%的aPTT测量值超出参考范围，而分别在13%和6.3%的患者中观察到CT受损。标准凝血试验结果在中位数53分钟后可用[四分位距（IQR）：45-63分钟]，而ROTEM（R）结果的10分钟值在23分钟后在线可用（IQR：21-24分钟）。PT和aPTT不能与ROTEM（R）CT互换使用。根据ROTEM（R）的结果，PT和aPTT的推荐阈值可能高估了凝血治疗的需要。纤维蛋白原水平和FibTEM检测之间存在良好的相关性。此外，ROTEM（R）提供了更快的周转时间。
Background. Thromboelastometry (ROTEM (R)) might be useful to detect intraoperative coagulation disorders early in major paediatric surgery. This observational trial compares this technique to standard coagulation tests.Methods. Intraoperative blood sampling was obtained in children undergoing elective major surgery. At each time point, standard coagulation tests [activated partial thromboplastin time (aPTT), prothrombin time (PT), and fibrinogen level] and ROTEM (R) analyses (InTEM, ExTEM, and FibTEM) were performed simultaneously by trained hospital laboratory staff.Results. A total of 288 blood samples from 50 subjects were analysed. While there was a poor correlation between PT and aPTT to ExTEM clotting time (CT) and InTEM CT, respectively, a good correlation was detected between PT and aPTT to clot formation time, and a very good correlation between fibrinogen level and FibTEM assay (r = 0.882, P < 0.001). Notably, 64% of PT and 94% of aPTT measurements were outside the reference range, while impaired CT was observed in 13% and 6.3%, respectively. Standard coagulation test results were available after a median of 53 min [inter-quartile range (IQR): 45-63 min], whereas 10 min values of ROTEM (R) results were available online after 23 min (IQR: 21-24 min).Conclusions. PT and aPTT cannot be interchangeably used with ROTEM (R) CT. Based on the results of ROTEM (R), recommended thresholds for PT and aPTT might overestimate the need for coagulation therapy. A good correlation was found between the fibrinogen level and the FibTEM assay. In addition, ROTEM (R) offered faster turnaround times.