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In Vitro Thrombosis Test for Ventricular Assist Devices
Published on: March 21, 2025
792
Distinctive Features of Rotational Thromboelastometry in Patients with Infective Endocarditis Undergoing on-Pump
Stanislaw Vander Zwaag1, Imre Kukel1, Kinga Towarek-Nocon2
1Department of Cardiac Anesthesiology, Medical Faculty and Heart Center Dresden, TUD Dresden University of Technology, Dresden, Germany.
Summary
Infective endocarditis patients undergoing cardiac surgery show distinct coagulation patterns, with longer clotting times and increased clot firmness. This necessitates greater use of prothrombin complex concentrate (PCC) to manage bleeding risks.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Anesthesiology
Background:
- The haemostatic system is implicated in valvular vegetations and coagulation abnormalities in infective endocarditis.
- Patients with endocarditis undergoing valvular surgery present complex coagulation challenges.
- Rotational thromboelastometry (ROTEM) is a point-of-care test for assessing coagulation.
Purpose of the Study:
- To investigate the unique viscoelastic properties of coagulation in endocarditis patients during cardiac surgery using ROTEM.
- To compare ROTEM findings between endocarditis patients and a matched control group undergoing valvular surgery.
- To assess the impact of endocarditis on the requirement for blood product transfusions.
Main Methods:
- Retrospective analysis of valvular surgery patients between May 2022 and August 2024.
- ROTEM assessments performed during extracorporeal circulation and post-heparin reversal.
- Propensity score matching used to create an endocarditis group and a control group (23 patients each).
Main Results:
- Endocarditis patients exhibited prolonged EXTEM clotting times (136s vs 96s) and higher FIBTEM-A5 clot firmness (19mm vs 13mm) compared to controls.
- Endocarditis patients required significantly more prothrombin complex concentrate (PCC) (3000 vs 2500 units).
- No significant differences were observed in transfusions of platelets, fresh frozen plasma (FFP), or fibrinogen concentrate (FC) between groups.
Conclusions:
- Endocarditis patients display distinct ROTEM profiles characterized by prolonged clotting and increased clot firmness.
- These findings suggest a need for increased PCC supplementation in endocarditis patients undergoing valvular surgery.
- Further research is required to optimize ROTEM parameters for balancing bleeding and thrombotic risks in this population.
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