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Updated: Jun 20, 2026
Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization
Published on: June 4, 2020
Differences in thromboelastometry parameters A10EXTEM and A10FIBTEM -as independent risk factors for mortality during
Hagen Bomberg1,2,3, Theresa Mokry4, Neeti Sharma5
1Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Balgrist University Hospital, University of Zurich, Forchstrasse 370, Zurich, 8008, Switzerland. hagen.bomberg@balgrist.ch.
Purpose:
During bleeding, the decrease A10EXTEM and A10FIBTEM (the clot firmness at 10 min) measured by rotational thromboelastometry (Rotem) can detect alterations in the fibrin contribution to clot firmness (FIBTEM) and in the extrinsic pathway (EXTEM). However, the significance of a decrease of A10FIBTEM and A10EXTEM for risk stratification in patients with bleeding remains unclear.
Methods:
1942 consecutive patients were retrospectively examined between 2014 and 2020. All patients were tested with Rotem during a hemorrhage at Saarland University Hospital. A10EXTEM and A10FIBTEM and their association with mortality at 30 days were tested using C statistic. A threshold value for A10EXTEM reaching a specificity > 90% for 30-day mortality was selected and for A10FIBTEM was fixed at <6 mm. Adjusted hazard ratios (adjHR [95% confidence interval]) were calculated with multivariable Cox models.
Results:
A10EXTEM (C statistic 0.57, selected threshold≤39 mm) had a predictive power for 30-day mortality, whereas A10FIBTEM did not. The 30-day mortality rate was significantly increased in patients with A10EXTEM≤39 mm (A10EXTEM≤39 mm: 32% versus A10EXTEM>39 mm: 16%, p < 0.001) and A10FIBTEM<6 mm (A10FIBTEM<6 mm: 25% versus A10FIBTEM≥6 mm: 18%, p = 0.03). The selected threshold values of A10EXTEM≤39 mm (adjHR 1.7 [1.3-2.3], p < 0.001) and A10FIBTEM<6 mm (adjHR 1.6 [1.1-2.2], p = 0.009) remained independent risk predictors for 30-day mortality even after adjustment for confounding factors. The leading cause of death in these populations were uncontrolled bleeding. Patients with A10FIBTEM<6 mm had significant more fibrinogen administration (A10FIBTEM<6 mm: 2.7 ± 3.7 g versus A10FIBTEM≥6 mm: 0.5 ± 1.6 g, p < 0.001).
Conclusion:
Our results indicate that A10EXTEM-detected alterations in the extrinsic pathway might be independent predictors for 30-day mortality in patients with bleeding. Nevertheless, A10FIBTEM measurements to optimize treatment with fibrinogen is required.