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Updated: Oct 4, 2025
Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization
Published on: June 4, 2020
Evaluation of health outcomes after the implementation of rotational thromboelastometry in patients undergoing
Isabel Rodríguez-Martín1, Catalina Sánchez-Mora1, Antonio R Fernández-López2
1Clinical Biochemistry Department, Virgen Macarena University Hospital, University of Seville, Sevilla, Spain.
Insights
Rotational thromboelastometry (ROTEM) monitoring in cardiac surgery significantly reduced blood transfusions and postoperative complications. This viscoelastic testing approach improved patient outcomes, including shorter ICU stays.
Area of Science:
- Anesthesiology and Perioperative Medicine
- Hematology and Coagulation Science
- Cardiovascular Surgery
Background:
- Perioperative coagulopathy is a significant challenge in cardiac surgery.
- Effective management of coagulation disorders is crucial for patient safety and outcomes.
- Viscoelastic testing, such as rotational thromboelastometry (ROTEM), offers real-time hemostasis monitoring.
Purpose of the Study:
- To evaluate the impact of implementing rotational thromboelastometry (ROTEM) and a specific coagulation management algorithm in cardiac surgery.
- To assess changes in allogeneic blood transfusion rates and postoperative complications following ROTEM implementation.
Main Methods:
- Retrospective cohort study involving 675 patients undergoing cardiac surgery with cardiopulmonary bypass.
- Analysis of allogeneic blood transfusion incidence and clinical postoperative complications.
- Comparison of outcomes before and after the implementation of ROTEM monitoring and a standardized algorithm.
Main Results:
- Overall allogeneic blood transfusion incidence decreased significantly (41.4% vs. 31.9%, p=0.026) post-ROTEM implementation.
- Significant reductions observed in packed red blood cell and fresh frozen plasma transfusions.
- Statistically significant decreases in postoperative bleeding (9.5% vs. 5.3%, p=0.037), surgical reexploration (6.0% vs. 2.9%, p=0.035), and ICU length of stay (p=0.026).
Conclusions:
- Perioperative hemostasis monitoring using ROTEM in cardiac surgery is associated with reduced allogeneic blood transfusions.
- ROTEM implementation led to a decrease in clinical hematologic postoperative complications.
- The use of ROTEM contributed to shorter intensive care unit (ICU) stays.
Background:
Viscoelastic tests (rotational thromboelastometry, ROTEM®), together with the implementation of a specific algorithm for coagulation management in cardiac surgery, enable perioperative coagulopathy to be better controlled.
Methods:
Retrospective cohort study including 675 patients who underwent cardiac surgery with cardiopulmonary bypass. The incidence of allogeneic blood transfusions and clinical postoperative complications were analyzed before and after ROTEM® implementation.
Results:
Following viscoelastic testing and the implementation of a specific algorithm for coagulation management, the incidence of any allogeneic blood transfusion decreased (41.4% vs 31.9%, p = .026) during the perioperative period. In the group monitored with ROTEM®, decreased incidence of transfusion was observed for packed red blood cells (31.3% vs 19.8%, p = .002), fresh frozen plasma (9.8% vs 3.8%, p = .008), prothrombin complex concentrate administration (0.9% vs 0.3%, p = .599) and activated recombinant factor VII (0.3% vs 0.0%, p = .603). Increased incidence was observed for platelet transfusion (4.8% vs 6.8%, p = .530) and fibrinogen concentrate (0.9% vs 3.5%, p = .066), tranexamic acid (0.0% vs 0.6%, p = .370) and protamine administration (0.6% vs 0.9%, p = .908). Similar results were observed in the postoperative period, but with a decreased incidence of platelet transfusion (4.8% vs 3.8%, p = .813). In addition, statistically significant reductions were detected in the incidence of postoperative bleeding (9.5% vs 5.3%, p = .037), surgical reexploration (6.0% vs 2.9%, p = .035), and length of Intensive Care Unit (ICU) stay (6.0 days vs 5.3 days, p = .026).
Conclusions:
The monitoring of hemostasis by ROTEM® in cardiac surgery, was associated with decreased incidence of allogeneic blood transfusion, clinical hematologic postoperative complications and lengths of ICU stay.
