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Updated: Jan 2, 2026
Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization
Published on: June 4, 2020
Comparison of standard coagulation testing with thromboelastometry tests in cardiac surgery
Elham Khalaf-Adeli1, Mostafa Alavi2, Alireza Alizadeh-Ghavidel3
1Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.
Insights
Thromboelastometry (TEM) offers a more comprehensive assessment of coagulation than standard tests during cardiac surgery. TEM provides faster, more accurate results for managing bleeding and reducing unnecessary blood transfusions.
Area of Science:
- Cardiovascular Surgery
- Hemostasis and Thrombosis
- Point-of-Care Testing
Background:
- Thromboelastometry (TEM) is a point-of-care test shown to reduce blood loss and transfusion needs in cardiac surgery.
- Limited comparative data exists between TEM and standard coagulation tests (SCTs) in this setting.
Purpose of the Study:
- To compare the diagnostic performance of TEM versus SCTs (prothrombin time, activated partial thromboplastin time, fibrinogen) in patients undergoing combined coronary-valve surgery.
Main Methods:
- Forty adult patients undergoing on-pump combined coronary-valve surgery were enrolled.
- Blood samples were collected pre- and post-cardiopulmonary bypass (CPB).
- TEM parameters (Fibtem, Intem, Extem, Heptem) and SCTs (PT, PTT, fibrinogen) were analyzed simultaneously.
Main Results:
- No significant correlation was found between PT/PTT and TEM parameters (CT-Extem, CT-Intem) pre- or post-CPB.
- Fibrinogen levels showed a strong correlation with TEM parameters (A10-Fibtem, A10-Extem) pre-CPB.
- A high percentage of SCTs were outside reference ranges (PT: 82%, PTT: 84%), while abnormal TEM results (CT-Extem, CT-Intem) were less frequent (17.9%).
Conclusions:
- Standard coagulation tests are time-consuming and may not accurately reflect the overall hemostatic status during cardiac surgery.
- TEM provides a more comprehensive and rapid assessment of coagulation compared to SCTs.
- Relying solely on SCTs can lead to inappropriate blood transfusions; TEM may improve perioperative hemostatic management.
Abstract:
According to the several evidences, using thromboelastometry as a point of care test can be effective in reduction in blood loss and transfusion requirements in cardiac surgeries. However, there are limited data regarding to the comparison of thromboelastometry and the standard coagulation tests. In this study, we compared thromboelastometry and standard coagulation tests (PT, PTT and fibrinogen level) in patients under combined coronary-valve surgery. Forty adult patients who were under on-pump combined coronary-valve surgery were included in this study. Thromboelastometry tests Fibtem, Intem, Extem and Heptem), along with standard coagulation tests (PT, PTT and fibrinogen assay) were simultaneously performed in two time points, before and after the pump (pre-CPB and post-CPB, respectively). A total of 80 blood samples were analyzed. There were no significant correlation between PT test and the CT-Extem parameter as well as PTT and CT-Intem parameter either in pre-CPB and post-CPB (P >0.05). On the contrary, fibrinogen level had high correlation with A10-Fibtem and A10-Extem in pre-PCB (P <0.05). 82% of PT and 84% of PTT measurements were outside the reference range, while abnormal CT in Extem and Intem was observed in 17.9%. For management of bleeding, adequate perioperative haemostatic monitoring is indispensable during cardiac surgery. Standard coagulation tests are time consuming and cannot be interchangeably used with thromboelastomety and relying on their results to decide whether blood transfusion is necessary, leads to the inappropriate transfusion.
