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Evaluation of dynamic parameters of thrombus formation measured on whole blood using rotational thromboelastometry in
David Faraoni1, Christian Fenger-Eriksen, Stephanie Gillard
1Department of Anaesthesiology, Centre Hospitalier Universitaire Brugmann - Queen Fabiola Children's University Hospital, Free University of Brussels, Brussels, Belgium; Department of Anesthesiology, Peri-operative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Insights
Dynamic thromboelastography (TEG) parameters, specifically total thrombus formation, can estimate coagulation phases in pediatric cardiac surgery patients. These findings may help predict the need for fresh frozen plasma transfusion post-surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Hemostasis and Thrombosis
- Thromboelastography
Background:
- Coagulation dynamics are crucial in pediatric cardiac surgery.
- Estimating thrombus formation velocity may predict hemostatic product needs.
- Current methods may not fully capture dynamic coagulation phases.
Purpose of the Study:
- To evaluate dynamic thromboelastography (TEG) parameters for assessing coagulation in pediatric patients undergoing cardiac surgery.
- To determine if total thrombus formation and maximum rate of thrombus formation can predict the need for fresh frozen plasma (FFP) transfusion.
Main Methods:
- Retrospective analysis of 49 children (<3 months) undergoing cardiac surgery.
- Comparison of EXTEM parameters (total thrombus formation, maximum rate of thrombus formation) between infants receiving FFP during bypass and those who did not.
- Use of receiver operating characteristic curves to identify predictive variables for postoperative FFP transfusion.
Main Results:
- Total thrombus formation and maximum rate of thrombus formation were significantly higher in children who received FFP.
- These dynamic TEG parameters demonstrated superior specificity in predicting postoperative FFP transfusion compared to traditional parameters like clotting time and maximal clot firmness.
Conclusions:
- Dynamic ROTEM(®) parameters, particularly total thrombus formation, can estimate coagulation amplification and propagation phases in pediatric patients.
- These parameters show potential for predicting hemostatic product requirements in children undergoing cardiac surgery with cardiopulmonary bypass.
Background:
Total thrombus formation velocity calculated using amplitude parameters obtained at different times could be used to estimate the amplification and the propagation phases observed during coagulation processes, and therefore might be useful to predict postoperative hemostatic products administration in pediatric patients.
Methods:
We retrospectively analyzed data from 49 children <3 months of age who underwent cardiac surgery. Children ≤1 month of age routinely received fresh frozen plasma during bypass while children >1 month of age did not. The EXTEM parameters were used to calculate velocity curves using amplitudes obtained at different times, the area under the curve called total thrombus formation and the maximum rate of thrombus formation. These parameters were compared between children who received fresh frozen plasma and those who did not. Receiver operating characteristics curves were used to define variables that could be used to predict postoperative fresh frozen plasma transfusion.
Results:
Total thrombus formation and maximum rate of thrombus formation significantly increased in children who received fresh frozen plasma compared to those who did not. Both total thrombus formation and maximum rate of thrombus formation have a better specificity to predict postoperative fresh frozen plasma transfusion compared to clotting time or maximal clot firmness.
Conclusion:
Based on this descriptive study, dynamic ROTEM(®) parameters of total thrombus formation could be used to estimate the amplification and the propagation phases of coagulation in children. These parameters might be used in further well-designed study to predict the need for hemostatic products in children undergoing cardiac surgery with cardiopulmonary bypass.
