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Thromboelastometry (ROTEM) Assessing Hypercoagulability in Patients Referred for Thrombophilia Screening
Mazen Assar1,2, Henning Nilius3, Natalie Kearn1
1Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada.
International Journal of Laboratory Hematology
|February 21, 2025
Summary
Rotational Thromboelastometry (ROTEM) can detect hypercoagulability in thrombophilia screening patients. However, it is not a strong discriminatory test for venous thromboembolism (VTE) risk or recurrence.
Area of Science:
- Hematology
- Clinical Pathology
- Thrombosis Research
Background:
- Thrombophilia, a disorder of blood coagulation, increases the risk of venous thromboembolism (VTE).
- Traditional coagulation assays may be insufficient for comprehensive VTE risk assessment.
- Global assays like Rotational Thromboelastometry (ROTEM) may offer additional insights into hypercoagulability.
Purpose of the Study:
- To investigate ROTEM's ability to detect hypercoagulability in patients undergoing thrombophilia screening.
- To assess ROTEM's potential impact on patient outcomes, specifically VTE risk and recurrence.
- To identify the limitations of ROTEM in thrombophilia assessment.
Main Methods:
- A comprehensive analysis of 356 patients referred for thrombophilia screening.
- Inclusion of clinical, laboratory, and genetic tests alongside ROTEM (EXTEM and INTEM) assessments.
- Statistical analysis using Mann-Whitney U and Chi-square tests to compare ROTEM parameters (clot formation time, alpha angle, maximum clot firmness) between patients with and without VTE history.
Main Results:
- A significant proportion of patients (64.6%) had a history of VTE, with many experiencing recurrent or unprovoked events.
- Patients with a history of VTE showed significant alterations in EXTEM and INTEM ROTEM parameters, indicating hypercoagulability (decreased CFT, increased AA and MCF).
- Receiver operating characteristic (ROC) curve analysis revealed that these ROTEM parameters could not reliably discriminate between patients with and without thromboembolic complications.
Conclusions:
- ROTEM demonstrates the capacity to detect hypercoagulability in patients undergoing thrombophilia screening.
- ROTEM is not identified as a strong discriminatory test for predicting VTE risk or recurrence based on this study.
- Prospective cohort studies are necessary to definitively determine if abnormal ROTEM findings correlate with an increased risk of VTE recurrence.
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