Rotation thromboelastometry detects thrombocytopenia and hypofibrinogenaemia during orthotopic liver transplantation

Area of Science:

• Anesthesiology
• Transplantation Surgery
• Hematology

Background:

• Orthotopic liver transplantation (OLT) carries a significant risk of hemorrhage, especially in patients with severe liver dysfunction.
• Effective coagulation monitoring is crucial for managing bleeding complications during OLT.

Purpose of the Study:

• To evaluate the utility of rotation thromboelastometry (ROTEM) for real-time coagulation monitoring in the operating theatre during OLT.
• To assess the correlation between ROTEM parameters and routine laboratory coagulation tests.
• To determine ROTEM's ability to guide platelet (Plt) and fibrinogen (Fg) transfusions.

Main Methods:

• A prospective observational study included 23 patients undergoing OLT.
• ROTEM tests (EXTEM, INTEM, FIBTEM, APTEM) and laboratory coagulation tests were performed six times per patient.
• Receiver-operating characteristic (ROC) curve analysis was used to establish thresholds for ROTEM parameters correlating with Plt count and Fg levels.

Main Results:

• The clot amplitude at 10 minutes (A10) in EXTEM showed strong correlations with both Plt count (R²=0.46) and Fg levels (R²=0.52).
• FIBTEM A10 demonstrated a significant correlation with Fg levels (R²=0.55).
• ROC analysis indicated that EXTEM A10 thresholds of 29 mm and 26 mm could predict thrombocytopenia and hypofibrinogenemia, respectively, with good sensitivity and specificity.

Conclusions:

• ROTEM provides a valuable global assessment of coagulation status in the operating theatre during liver transplantation.
• The EXTEM assay is particularly informative for evaluating the overall coagulation process.
• The A10 parameter from EXTEM is a useful guide for timely and appropriate platelet and fibrinogen transfusions.