Comparing Rotational Thromboelastometry and Standard Coagulation Assays for Predicting Intraoperative Bleeding in...

Area of Science:

• Pediatric Surgery
• Anesthesiology
• Hematology
• Transplantation Medicine

Background:

• Predicting intraoperative bleeding in pediatric liver transplantation (OLT) using preoperative coagulation tests is crucial for patient outcomes.
• The comparative utility of rotational thromboelastometry (ROTEM) versus standard coagulation assays (SCAs) in this context remains incompletely understood.

Purpose of the Study:

• To compare the predictive accuracy of preoperative ROTEM parameters and SCAs for significant intraoperative bleeding in children undergoing OLT.
• To identify specific coagulation parameters that are independently associated with intraoperative blood loss in this pediatric cohort.

Main Methods:

• A retrospective cohort study of pediatric OLT recipients was conducted.
• Preoperative ROTEM parameters (INTEM MCF, EXTEM CT, INTEM CT, FIBTEM MCF) and corresponding SCAs (platelet count, INR, aPTT, fibrinogen) were assessed for their ability to predict significant intraoperative bleeding (blood loss ≥ 85th percentile).

Main Results:

• Seventy-two children were analyzed, with 17% experiencing significant intraoperative bleeding.
• Both ROTEM and SCAs demonstrated strong correlations, with notable exceptions (e.g., EXTEM CT and INR).
• A combination of SCAs outperformed ROTEM in predicting bleeding (AUC 0.862 vs. 0.760), and only platelet count was independently associated with significant bleeding (aOR 1.02).

Conclusions:

• ROTEM parameters and SCAs exhibit comparable predictive values for intraoperative bleeding in pediatric liver failure patients undergoing OLT.
• Current evidence suggests SCAs, particularly platelet count, may be more reliable predictors.
• Further research is warranted to optimize the use of ROTEM in managing coagulopathy during pediatric OLT.