Rotational Thromboelastometry Predicts Transfusion Requirements in Total Joint Arthroplasties

Area of Science:

• Anesthesiology and Perioperative Medicine
• Hematology and Coagulation Science
• Orthopedic Surgery

Background:

• Red blood cell (RBC) transfusions are common in total joint arthroplasties (TJA).
• Hemorrhagic risk in TJA is influenced by surgical and patient factors.
• Predictive tools for transfusion and bleeding are crucial for patient management.

Purpose of the Study:

• To evaluate the utility of rotational thromboelastometry (ROTEM) in identifying patients at high risk for transfusion and excessive bleeding after TJA.
• To correlate ROTEM parameters with transfusion requirements and postoperative blood loss.

Main Methods:

• Prospective observational study of 206 patients undergoing total knee or hip arthroplasty.
• Preoperative and postoperative coagulation status assessed using ROTEM and conventional tests.
• Recorded RBC transfusions and postoperative hemoglobin drop.

Main Results:

• Higher postoperative FIBTEM maximum clot firmness (MCF) correlated with reduced risk of transfusion (OR: 0.66) and excessive bleeding (OR: 0.58).
• Postoperative FIBTEM MCF ≤10mm showed 80.1% sensitivity and 75.5% specificity for predicting transfusion.
• ROTEM demonstrated high predictive accuracy for transfusion and bleeding, with an 86.3% transfusion probability for FIBTEM MCF 0-4mm.

Conclusions:

• ROTEM is a valuable tool for predicting transfusion requirements and excessive bleeding in TJA patients.
• Early identification of high-risk patients enables proactive blood bank management and targeted blood-saving strategies.
• FIBTEM MCF is a key parameter for risk stratification in perioperative coagulation management.