Thromboelastometry profile in critically ill patients: A single-center, retrospective, observational study

Area of Science:

• Critical Care Medicine
• Hematology
• Laboratory Diagnostics

Background:

• Transfusion therapy is linked to increased patient morbidity, mortality, and healthcare expenses.
• Conventional coagulation tests (CCT) are inadequate predictors of bleeding and do not accurately reflect in vivo coagulation.
• Thromboelastometry (ROTEM) offers early detection of coagulation disorders and goal-directed transfusion guidance, potentially reducing blood component use.

Purpose of the Study:

• To characterize the coagulation profile of critically ill patients utilizing ROTEM.
• To assess the correlation between CCT and ROTEM findings in this patient population.

Main Methods:

• Retrospective, observational study in a medical-surgical intensive care unit (ICU).
• Included 531 adult patients who underwent ROTEM analysis for bleeding management between November 2012 and December 2014.
• Simultaneous recording of the first ROTEM and CCT post-ICU admission, along with data on blood product transfusion and hemostatic agents.

Main Results:

• The majority of ROTEM tests indicated normal coagulation: INTEM (54.8%), EXTEM (54.1%), and FIBTEM (53.3%).
• Discrepancies were noted between ROTEM and CCT, with CCT suggesting coagulopathy (e.g., prolonged aPTT, elevated INR) in some patients with normal ROTEM results.
• Despite normal ROTEM findings, 16.7% of patients received platelet concentrates and 10% received fresh frozen plasma.

Conclusions:

• Critically ill patients predominantly exhibit normal coagulation profiles as assessed by ROTEM.
• CCT may overestimate coagulopathy, potentially leading to unnecessary allogeneic blood product transfusions.
• ROTEM-guided management may help avoid inappropriate transfusions in critically ill patients.