A clotting time longer than 226 s in the INTEM channel of the thromboelastometer is an independent risk factor for mortality during bleeding

During bleeding the prolongation of the clotting time (CT_INTEM) measured by rotational thromboelastometry (ROTEM) can detect alterations in the intrinsic pathway; however, the significance of a prolonged CT_INTEM for risk stratification in patients with bleeding and the treatment with fresh frozen plasma remains unclear.

A total of 2197 consecutive patients between 2014 and 2020 were retrospectively investigated. All patients were tested by ROTEM during bleeding at the Saarland University Hospital. The CT_INTEM values were compared to mortality at 30 days. Discrimination was assessed with C statistic. Adjusted hazard ratios (adjHR, 95% confidence interval, CI) were calculated with multivariable Cox models.

The results of the C‑statistic showed that CT_INTEM (C statistic 0.62, optimal threshold > 226 s) had a predictive power for 30-day mortality. The determined threshold value of CT_INTEM > 226 s remained an independent risk predictor for 30-day mortality even after adjustment for confounding factors (adjHR 2.6, 95% CI 2.1-3.2, p < 0.001). The 30-day mortality rate was significantly increased in the group with CT_INTEM > 226 s (29% versus 15%, p < 0.001). A multivariable analysis showed that treatment with fresh frozen plasma was not associated with increased 30-day mortality in patients with CT_INTEM > 226 s, in contrast to all patients.

Our results indicate that CT_INTEM > 226s detected alterations in the intrinsic pathway might be an independent predictor for 30-day mortality in patients with bleeding and could be useful for decision making regarding treatment with fresh frozen plasma.