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Related Experiment Video

Updated: Jan 6, 2026

Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization
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Rotational Thromboelastometry (ROTEM) Versus Conventional Coagulation Tests in Cirrhosis: Can We Reduce Plasma

Nuanrat Cheerasiri1, Ratchaneekorn Jantasing1, Rapat Pittayanon2,3

  • 1Center of Excellence in Translational Hematology, Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.

Journal of Clinical Laboratory Analysis
|November 25, 2025
PubMed
Summary

Rotational thromboelastometry (ROTEM) strongly correlates with conventional coagulation tests (CCTs) in cirrhosis patients but does not improve detection of rebalanced hemostasis. Adjusting transfusion thresholds for PT-R and platelet count may reduce unnecessary transfusions.

Keywords:
blood coagulation testshemorrhagehemostasisliver cirrhosisthromboelastography

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Area of Science:

  • Hepatology
  • Coagulation Science
  • Transfusion Medicine

Background:

  • Periprocedural rotational thromboelastometry (ROTEM) is explored for reducing transfusions in cirrhosis.
  • Uncertainty exists whether ROTEM benefits stem from higher transfusion thresholds or detecting rebalanced hemostasis.

Purpose of the Study:

  • To assess the correlation between conventional coagulation tests (CCTs) and ROTEM in cirrhotic patients.
  • To determine if ROTEM shares CCT limitations, particularly regarding anticoagulant protein levels.

Main Methods:

  • A cohort study analyzed blood samples from cirrhotic patients undergoing elective endoscopy.
  • Correlations between CCT parameters (PT-R) and ROTEM variables (EXTEM-CT, EXTEM-MCF) were evaluated.
  • Anticoagulant protein levels were measured to assess ROTEM's limitations.

Main Results:

  • High correlations were found between PT-R and EXTEM-CT, platelet count and EXTEM-MCF, and fibrinogen and FIBTEM/EXTEM-MCF.
  • Only 41.7% of patients with PT-R > 1.5 exceeded the ROTEM transfusion threshold.
  • Low platelet counts correlated with impaired EXTEM-MCF; prolonged EXTEM-CT was linked to lower protein C and antithrombin levels.

Conclusions:

  • ROTEM shows strong correlation with CCTs but does not overcome their limitations in detecting rebalanced hemostasis.
  • Prophylactic transfusions based solely on abnormal ROTEM or CCTs should be avoided.
  • Increasing transfusion thresholds for PT-R (>1.8) and platelet count (<40 × 10^9/L) during active bleeding may reduce unnecessary transfusions.