Background: Rotational thromboelastometry (ROTEM) is a viscoelastic point-of-care device that measures clot formation in whole blood. It is currently used for transfusion management during cardiac surgery, liver transplantation and post-trauma care.

Aims: We aimed to evaluate whether ROTEM has additional value in excluding presence of anticoagulants and antiplatelet drugs.

Methods: In this prospective cohort 442 vulnerable patients that received PCI at MUMC+ between May 2014 and January 2019 were included. Vulnerable patients are defined as having ≥3 risk factors for either ischemic or bleeding events. Patients’ 1 month post-PCI treatment consisted of a combination of a P2Y12 inhibitor with either aspirin (dual antiplatelet therapy; DAPT, n=324), a vitamin K antagonist (VKA; n=70) or a direct oral anticoagulant (DOAC; n=48). Four ROTEM assays (INTEM, EXTEM, tPA and FIBTEM) were performed and compared with a control group of 95 patients undergoing preoperative screening and not using antithrombotic medication.

Results: EXTEM CT was out of reference range (36-60 s) for all patients on anticoagulants, with respectively a median and range of 122s (74-203) and 132s (62-256) for VKA+P2Y12 and DOAC+P2Y12. Neither of the 4 ROTEM assays detected the use of DAPT when CT was compared to the control patients. Remarkably, both patients on DAPT and VKA/DOAC + P2Y12 showed significantly higher MCF and lower CFT for the EXTEM, INTEM and FIBTEM assays when compared to the control group.

Conclusions: An Extem CT within reference range can exclude the presence of anticoagulants
(in combination with a P2Y12 inhibitor) in this cohort. ROTEM CT cannot detect the use of DAPT, but surprisingly, an effect on CFT and MCF can be seen for DAPT. Mechanisms underlying this phenomenon remain to be investigated.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/excluding-anticoagulants-and-antiplatelet-drugs-with-rotational-thromboelastometry/