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Early thromboelastometric variables reliably predict maximum clot firmness in patients undergoing cardiac surgery: a step towards earlier decision making
Author(s) -
DIRKMANN D.,
GÖRLINGER K.,
DUSSE F.,
KOTTENBERG E.,
PETERS J.
Publication year - 2013
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12040
Subject(s) - medicine , thromboelastometry , protamine , activated clotting time , heparin , cardiopulmonary bypass , receiver operating characteristic , clotting time , anesthesia , area under the curve , coagulation , cardiac surgery , cardiology
Background While much effort has been spent on guiding coagulation and transfusion therapy in patients undergoing cardiopulmonary bypass ( CPB ) surgery, the use of conventional laboratory‐based coagulation tests is hampered by long turnaround times and interference with heparin and protamine. To allow faster assessment of maximum clot firmness ( MCF ) by point‐of‐care thromboelastometry ( ROTEM ®, TEM International GmbH, Munich, Germany), we tested whether clotting time ( CT ), clot formation time ( CFT ), or early values of clot firmness ( CF ) predict MCF . Methods Results of 437 ROTEM ® assays ( EXTEM ®, INTEM ®, FIBTEM ®, and HEPTEM ®) from 84 patients undergoing CPB surgery were analyzed. Measurements were performed prior to and after heparin administration, as well as after protamine administration and CT , CFT , and CF after 5, 10, and 15 min ( A 5, A 10, and A 15) after initial clotting ( CT ) were related to MCF . Statistics Regression and Bland–Altman analyses and receiver‐operating characteristics ( ROC s). Results CFT (r = 0.87–0.95), A5 (r = 0.84−0.98; P < 0.0001), A10 (r = 0.86−0.98; P < 0.0001), and A15 (r = 0.86−0.98; P < 0.0001) demonstrated high correlation coefficients with MCF , whereas CT correlated weakly (r = 0.07−0.41). As expected, correlation coefficients increased with the time allowed to assess a specific variable. ROC analyses demonstrated excellent accuracy for CFT , A 5, A 10, and A 15 [area under the curve ( AUC ): 0.9476−0.9931] to predict a subnormal MCF , whereas CT demonstrated poor accuracy ( AUC : 0.5796−0.6774). Conclusion Taking into account specific bias, early values of CF ( A 5– A 15) reliably predict maximum CF under all conditions and, therefore, allow for marked time savings in the interpretation of ROTEM ® measurements. This may guide earlier and more specific treatment of CPB ‐related coagulation disorders.