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Thromboelastometry, Thromboelastography, and Conventional Tests to Assess Anticoagulation During Extracorporeal
Marco Giani1,2, Vincenzo Russotto1,2, Matteo Pozzi1
1From the ASST Monza, Ospedale San Gerardo, Dipartimento di Emergenza-Urgenza, Monza, Italy.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|January 29, 2021
Summary
Rotational thromboelastometry (ROTEM) showed moderate correlation with standard coagulation tests for monitoring unfractionated heparin anticoagulation during extracorporeal membrane oxygenation (ECMO). Further research is needed to establish ROTEM targets for ECMO patients.
Area of Science:
- Critical Care Medicine
- Hematology
- Medical Technology
Background:
- Extracorporeal membrane oxygenation (ECMO) requires precise anticoagulation monitoring to prevent bleeding and clotting complications.
- Viscoelastic hemostatic assays (VHA), such as thromboelastography (TEG), are increasingly used, but data on rotational thromboelastometry (ROTEM) in ECMO is limited.
Purpose of the Study:
- To evaluate ROTEM's utility in assessing hemostasis in adult ECMO patients.
- To compare ROTEM results with TEG and conventional coagulation assays during unfractionated heparin (UFH) anticoagulation.
Main Methods:
- Prospective, observational, single-center study involving 25 adult ECMO patients.
- Analysis of Kaolin reaction time (TEG) and INTEM clotting time (ROTEM) alongside conventional coagulation tests.
- Comparison of ROTEM INTEM CT with activated partial thromboplastin time (aPTT) and activated clotting time (ACT).
Main Results:
- ROTEM INTEM CT demonstrated a moderate correlation with aPTT (R²=0.34) and ACT (R²=0.3) (p < 0.001).
- No significant correlation was observed between ROTEM INTEM CT and TEG Kaolin R time (R²=0.01).
- Median UFH infusion rate was 15 IU/min/kg.
Conclusions:
- ROTEM shows potential as a tool for monitoring anticoagulation in ECMO, correlating moderately with standard tests.
- Further investigation is required to determine optimal ROTEM-based anticoagulation targets for ECMO patients.
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