Using Rotational Thromboelastometry (ROTEM) to Evaluate Coagulation Status After Intrapleural Recombinant Tissue...

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Hematology

Background:

• Patients undergoing thoracotomy for empyema may receive intrapleural recombinant tissue plasminogen activator (rtPA) to manage pleural space infections.
• Assessing coagulation status is crucial before administering regional anesthesia in such patients due to potential bleeding risks.
• Traditional coagulation tests may not fully capture the dynamic effects of rtPA on clot formation and lysis.

Observation:

• A 45-year-old male, post-thoracotomy for empyema and treated with intrapleural rtPA, required regional anesthesia for pain management.
• The acute pain service utilized rotational thromboelastometry (ROTEM) to evaluate the patient's coagulation profile.
• ROTEM analysis revealed normal to hypercoagulable clotting parameters with a normal extrinsic thromboelastometry (EXTEM) lysis index at 30 minutes.

Findings:

• The ROTEM results indicated no significant systemic anticoagulation or fibrinolytic effects from the intrapleural rtPA administration.
• These findings provided reassurance regarding the patient's coagulation status.
• A single-shot paravertebral block was successfully performed, followed by thoracic epidural analgesia without complications.

Implications:

• ROTEM serves as a valuable tool for assessing coagulation in patients treated with intrapleural rtPA.
• It facilitates informed decision-making regarding the safety of regional anesthesia in this specific clinical scenario.
• This case supports the use of ROTEM to mitigate risks associated with regional anesthesia following rtPA administration, potentially improving pain management strategies in thoracic surgery patients.