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Early thromboelastometry variables predict maximum clot firmness in children undergoing cardiac and non-cardiac

A Perez-Ferrer1, J Vicente-Sanchez1, M D Carceles-Baron2

  • 1Department of Anaesthesiology, La Paz University Hospital, Madrid, Spain.

British Journal of Anaesthesia
|November 20, 2015
PubMed

Insights

Early clot amplitudes measured on rotational thromboelastometry (ROTEM®) can predict maximum clot firmness (MCF) in pediatric patients. This finding supports using early ROTEM® variables for assessing clot strength in children undergoing surgery.

Area of Science:

  • Pediatric Anesthesiology
  • Hemostasis and Thrombosis Research
  • Point-of-Care Testing

Background:

  • Rotational thromboelastometry (ROTEM®) is a viscoelastic assay used to assess hemostasis.
  • Early clot amplitudes in ROTEM® have been shown to predict maximum clot firmness (MCF) in adults.
  • The predictive value of early ROTEM® variables for MCF in pediatric surgical patients was previously unconfirmed.

Purpose of the Study:

  • To confirm the correlation between early clot amplitudes and MCF in children.
  • To evaluate the predictive accuracy of early ROTEM® variables across various test assays in pediatric patients.
  • To establish the utility of early ROTEM® measurements in pediatric cardiac and non-cardiac surgery.

Main Methods:

  • Retrospective analysis of 4762 ROTEM® tests (EXTEM, INTEM, FIBTEM, APTEM, HEPTEM) from pediatric patients.
  • Correlation analysis (Spearman's coefficient) between clot amplitudes at 5, 10, and 15 minutes and MCF.
  • Receiver operating characteristics (ROC) analysis to assess predictive performance.

Main Results:

  • Strong correlations were observed between early clot amplitudes (A5, A10, A15) and MCF for EXTEM, INTEM, and FIBTEM tests (r values ranging from 0.91 to 0.97, P<0.001).
  • Similar strong correlations were found for APTEM and HEPTEM tests.
  • ROC analysis confirmed that early clot amplitudes reliably predicted MCF across all ROTEM® assays.

Conclusions:

  • Early clot amplitudes measured as early as 5, 10, or 15 minutes after clotting time accurately predict MCF in pediatric patients.
  • These findings validate the use of early ROTEM® measurements for assessing hemostasis in children undergoing surgery.
  • The study supports the integration of early ROTEM® variable assessment into pediatric perioperative hemostasis management.
Abstract

Keywords:
blood coagulationblood transfusionchildrenmeasurement techniquesthromboelastometrytransfusion algorithm

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