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Thromboelastometry as an Alternative Method for Coagulation Assessment in Pediatric Patients Undergoing Invasive

Miroslav Durila1, Jakub Jonas1, Marianna Durilova2

  • 1Department of Anesthesiology and Intensive Care Medicine, Motol University Hospital, Second Faculty of Medicine, Charles University, Prague, Czech Republic.

European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [Et Al] = Zeitschrift Fur Kinderchirurgie
|August 2, 2018
PubMed

Insights

In pediatric patients, normal rotational thromboelastometry (ROTEM) results despite prolonged standard coagulation tests (activated partial thromboplastin time [aPTT] and prothrombin time [PT]) were not associated with severe bleeding during invasive procedures.

Area of Science:

  • Pediatric critical care medicine
  • Hemostasis and thrombosis
  • Point-of-care diagnostics

Background:

  • Standard coagulation tests (aPTT, PT) assess coagulation but don't reflect whole blood dynamics.
  • Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic test evaluating whole blood coagulation.
  • Discrepancies between ROTEM and standard tests may occur in critically ill children.

Purpose of the Study:

  • To investigate severe bleeding risk in pediatric patients with normal ROTEM but prolonged aPTT/PT.
  • To evaluate ROTEM as a reliable alternative for coagulation assessment in pediatric invasive procedures.

Main Methods:

  • Retrospective analysis of pediatric patient data (2015-2017).
  • Included patients with prolonged aPTT or PT and normal ROTEM (INTEM and EXTEM).
  • Assessed for severe bleeding during or after invasive procedures.

Main Results:

  • 26 pediatric patients (2 months-17 years) had normal INTEM/EXTEM with prolonged aPTT/PT ratios.
  • Median aPTT ratio was 1.47, INR 1.4, and PT ratio 1.30.
  • No severe bleeding events were observed during or after invasive procedures.

Conclusions:

  • ROTEM can be a reliable alternative coagulation test in pediatric patients undergoing invasive procedures.
  • Normal ROTEM with prolonged PT/aPTT suggests no increased bleeding risk.
  • ROTEM may reduce fresh frozen plasma administration and expedite patient preparation.
Abstract

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