Related Experiment Video
Updated: Jun 20, 2026
06:28
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.
Langenbeck'S Archives of Surgery
|June 18, 2026
Summary
Rotational thromboelastometry (Rotem) A10EXTEM measurements can predict mortality in bleeding patients. A10FIBTEM is useful for guiding fibrinogen treatment, but not for risk stratification.
Area of Science:
- Critical Care Medicine
- Hematology
- Surgical Hemostasis
Background:
- Rotational thromboelastometry (Rotem) provides real-time assessment of hemostasis.
- A10EXTEM and A10FIBTEM, clot firmness at 10 minutes, reflect extrinsic pathway and fibrinogen function, respectively.
- The prognostic significance of decreased A10EXTEM and A10FIBTEM in bleeding patients requires clarification.
Purpose of the Study:
- To evaluate the association between A10EXTEM and A10FIBTEM values and 30-day mortality in patients experiencing hemorrhage.
- To determine the utility of these Rotem parameters for risk stratification in bleeding patients.
Main Methods:
- Retrospective analysis of 1942 patients undergoing Rotem during hemorrhage (2014-2020).
- Association of A10EXTEM and A10FIBTEM with 30-day mortality assessed using C statistics.
- Thresholds determined for A10EXTEM (>90% specificity for mortality) and A10FIBTEM (<6 mm).
- Multivariable Cox models calculated adjusted hazard ratios (adjHR).
Main Results:
- A10EXTEM ≤39 mm demonstrated predictive power for 30-day mortality (C statistic 0.57).
- Mortality rates were significantly higher for patients with A10EXTEM ≤39 mm (32%) and A10FIBTEM <6 mm (25%).
- Both A10EXTEM ≤39 mm (adjHR 1.7) and A10FIBTEM <6 mm (adjHR 1.6) were independent predictors of 30-day mortality.
- Uncontrolled bleeding was the primary cause of death.
- Patients with A10FIBTEM <6 mm received significantly more fibrinogen (2.7 g vs 0.5 g).
Conclusions:
- A10EXTEM-derived alterations in the extrinsic pathway are independent predictors of 30-day mortality in bleeding patients.
- A10FIBTEM measurement is crucial for optimizing fibrinogen treatment in these patients.
- Rotem parameters offer valuable insights into risk stratification and treatment guidance during hemorrhage.