Abstract Number: PB0303
Meeting: ISTH 2020 Congress
Theme: Coagulation and Natural Anticoagulants » Critical Care and Perioperative
Background: Thromboelastometry ROTEM® is a technique used in CVS for hemostatic and transfusion monitoring, and a correct interpretation of its parameters on the contribution of platelets and fibrinogen to the blood clot is needed.
Aims: To evaluate PLTEM at 5-10 minutes (PLTEM5 and PLTEM10) and at maximum clot firmness (PLTEMMCF), their correlation with PLT, and probable effect of HTC and Fibrinogen as FIBTEM MCF (FIBTEMMCF) or factors as EXTEM CT (EXTEMCT).
Methods: A total of 651 samples corresponding to baseline and post-protamine stages from CVS patients (adults and pediatrics under 4 y.o., during 2015-2019 period).
Instrument: Thromboelastometer ROTEM delta®️ (Instrumentation Laboratory).
HTC and PLT: HemoCell CxH800 (Beckman Coulter)
Statistics: SPSS 23 software.
Results: Results are shown in tables 1-2.
As expected, the PLTEMs are greater for PLT≤100×109/L than 50×109/L and increases over time (PLTEMMCF>PLTEM10>PLTEM5).
The PLTEM-PLT Quadratic R2 (R2) are smaller for FIBTEMMCF>10mm than for ≤10 only in adults. Most pediatrics R2 are higher than adults regardless of FIBTEMMCF. The highest R2 is observed in pediatrics with HTC≤30% and FIBTEMMCF≤10mm.
Adults ROC-AUC are generally higher for HTC≤30% and FIBTEMMCF≤10mm, and greater for PLT≤50×109/L. Pediatrics´ ROC-AUC are higher than adults´, for both PLT≤50 and 100×109/L.
PLTEM cut-off values (COV) were selected with good sensitivity and intermediate specificity. PLTEM-COV are higher in pediatrics than adults when HTC≤30% and FIBTEMMCF≤10mm. Pediatrics R2 are better than adults ones when EXTEMCT is < 90 sec. However, COV calculated at any running time did not show any effect of EXTEMCT on PLTEM (data not shown).
Conclusions: Concluding, PLTEM reflects PLT in TEMograms amplitudes , but with some variability according to patient conditions. It seems to be a more accurate tool when CVS patients present low HTC and FIBTEMMCF, particularly in pediatrics. This must be kept in mind when PLTs transfusion is considered to improve hemostasis.
| ADULTS | PLTEM5 (mm) | PLTEM10 (mm) | PLTEMMCF (mm) | ||||
| HTC ≤30% | HTC >30% | HTC ≤30% | HTC >30% | HTC ≤30% | HTC >30% | ||
| CUADRATIC R2 FIBTEMMCF ≤10 | 0.503 (n=29) | 0.695 (n= 8) | 0.567 (n=29) | 0.669 (n=8) | 0.540 (n=29) | 0.701 (n=8) | |
| CUADRATIC R2 FIBTEMMCF >10 | 0.422 (n=377) | 0.222 (n=139) | 0.361 (n= 377) | 0.227 (n=139) | 0.230 (n=377) | 0.156 (n=139) | |
| ROC CURVE PLATELETS ≤50×109/L | AUC / CUT OFF VALUE (%Sensitivity/%Specificity) FIBTEMMCF≤10 | 0.946 / 14.5 (93/100) | – | 1.000 / 20.5 (100/100) | – | 0.929 / 31.0 (96/100) | – |
| ROC CURVE PLATELETS ≤50×109/L | AUC / CUT OFF VALUE (%Sensitivity/%Specificity) FIBTEMMCF>10 | 0.717 / 19.5 (83/47) | – | 0.718 / 24.5 (95/33) | – | 0.649 / 33.5 (90/27) | – |
| ROC CURVE PLATELETS ≤100×109/L | AUC / CUT OFF VALUE (%Sensitivity/%Specificity) FIBTEMMCF≤10 | 0.876 / 15.5 (100/47) | 0.917 / 14.5 (100/50) | 0.910 / 24.5 (100/53) | 0.917 / 22.5 (100/50) | 0.926 / 37.5 (100/80) | 0.917 / 29.0 (100/50) |
| ROC CURVE PLATELETS ≤100×109/L | AUC / CUT OFF VALUE (%Sensitivity/%Specificity) FIBTEMMCF>10 | 0.823 / 20.5 (91/48) | 0.866 / 19.5 (92/36) | 0.813 / 28.5 (94/42) | 0.863 / 29.5 (92/64) | 0.769 / 35.5 (92/33) | 0.818 / 37.5 (91/50) |
[Table 1: Statistics for adult patients. AUC: Area under de curve MCF: maximum clot firmness.]
| PEDIATRICS | PLTEM5 (mm) | PLTEM10 (mm) | PLTEMMCF (mm) | ||||
| HTC ≤30% | HTC >30% | HTC ≤30% | HTC >30% | HTC ≤30% | HTC >30% | ||
| CUADRATIC R2 FIBTEMMCF ≤10 | 0.760 (n=8) | 0.547 (n= 26) | 0.709 (n=8) | 0.515 (n=26) | 0.807 (n=8) | 0.469 (n=26) | |
| CUADRATIC R2 FIBTEMMCF >10 | 0.726 (n=14) | 0.597 (n=50) | 0.664 (n= 14) | 0.546 (n=50) | 0.619 (n=14) | 0.410 (n=50) | |
| ROC CURVE PLATELETS ≤50×109/L | AUC / CUT OFF VALUE (%Sensitivity/%Specificity) FIBTEMMCF≤10 | 1.000 / 16.0 (100/100) | 0.850 / 11.0 (95/33) | 1.000 / 24.0 (100/100) | 0.854 / 20.5 (90/33) | 1.000 / 32.5 (100/100) | 0.867 / 30.5 (90/50) |
| ROC CURVE PLATELETS ≤50×109/L | AUC / CUT OFF VALUE (%Sensitivity/%Specificity) FIBTEMMCF>10 | 0.939 / 13.5 (91/67) | 0.951 / 15.5 (96/50) | 0.939 / 20.5 (91/100) | 0.945 / 26.0 (94/75) | 0.978 / 24.5 (100/33) | 0.951 / 31.5 (98/75) |
| ROC CURVE PLATELETS ≤100×109/L | AUC / CUT OFF VALUE (%Sensitivity/%Specificity) FIBTEMMCF≤10 | 1.000 / 21.5 (100/100) | 0.938 / 18.5 (97/67) | 1.000 / 24.0 (100/100) | 0.958 / 27.5 (100/71) | 1.000 / 38.0 (100/100) | 0.958 / 37.5 (100/94) |
| ROC CURVE PLATELETS ≤100×109/L | AUC / CUT OFF VALUE (%Sensitivity/%Specificity) FIBTEMMCF>10 | 1.000 / 19.0 (100/80) | 0.938 / 18.5 (97/67) | 0.896 / 26.0 (87/63) | 0.911 / 28.5 (95/67) | 0.875 / 33.5 (87/67) | 0.888 / 32.5 (100/50) |
[Table 2: Statistics for pediatrics patients. AUC: Area under de curve MCF: maximum clot firmness.]
To cite this abstract in AMA style:
López MS, Mileo FG, Barrera LH, Oyhamburu J, Martinuzzo ME. Assessment of the Difference Between EXTEM and FIBTEM Amplitudes (PLTEM) and Their Correlation with Platelet Count (PLT), and the Effect of Fibrinogen and Hematocrit (HTC) in Cardiovascular Surgery (CVS) [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/assessment-of-the-difference-between-extem-and-fibtem-amplitudes-pltem-and-their-correlation-with-platelet-count-plt-and-the-effect-of-fibrinogen-and-hematocrit-htc-in-cardiovascular-surgery-c/. Accessed September 22, 2023.« Back to ISTH 2020 Congress
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