Thromboelastometry during Labor and after Delivery

The normal values of thromboelastometry (MonoTEM-A?, Framar Hemologix) in pregnancy have not been determined. The aim of this study was to establish the reference ranges for the thromboelastometer in healthy pregnant women during labor and after delivery. After ethical institutional approval and informed consent, we collected blood samples for analysis from 95 healthy labouring women and 40 volunteers (non pregnant women, control group). A sample of 360 μL of whole native blood was tested using the MonoTEM-A? equipment and analyzed within 4 min, at 37℃. We recorded: R = time to initial fibrin formation;K = time to initial clot formation;Alpha Angle = acceleration of clot formation and MA = strength of the blood clot. When compared to the control group, R and K values were lower in women during labor and after the delivery. The Alpha angle and MA values were higher in the laboring women and in the same women after delivery as compared to the control group. Our study determined the reference ranges for the MonoTEM-A? in pregnancy during labor and immediately after the delivery. Data obtained from thromboelastometry confirm the hypercoagulability status in pregnancy and the puerperium. MonoTEM-A? thromboelastometry may be a very useful tool to assess the clotting activity in this patient setting.

Prediction of return of spontaneous circulation in outof-hospital cardiac arrest with non-shockable initial rhythm using point-of-care testing: a retrospective observational study

BACKGROUND:Out-of-hospital cardiac arrest(OHCA) is a public health concern, and many studies have been conducted on return of spontaneous circulation(ROSC) and its prognostic factors.Rotational thromboelastometry(ROTEM?), a point-of-care testing(POCT) method, has been useful for predicting ROSC in patients with OHCA, but very few studies have focused on patients with non-shockable rhythm. We examined whether the parameters of POCT could predict ROSC in patients with OHCA and accompanying non-shockable rhythm.METHODS:This is a single-center, retrospective observational study. Complete blood count,blood gas, and ROTEM POCT measurements were used. This study included patients with nontraumatic OHCA aged 18 years or older who were transported to the emergency department and evaluated using POCT between January 2013 and December 2021. The patients were divided into the ROSC and non-ROSC groups. Prehospital information and POCT parameters were compared using receiver operating characteristic(ROC) curve analysis, and further logistic regression analysis was performed.RESULTS:Sixty-seven and 135 patients were in the ROSC and non-ROSC groups,respectively. The ROC curves showed a high area under the curve(AUC) for K^(+) of 0.77(95%confidence interval [CI]:0.71–0.83) and EXTEM amplitude 5 min after clotting time(A5) of 0.70(95%CI:0.62–0.77). The odds ratios for ROSC were as follows:female sex 3.67(95%CI:1.67–8.04);K^(+)0.64(95%CI:0.48–0.84);and EXTEM A5 1.03(95%CI:1.01–1.06).CONCLUSION:In OHCA patients with non-shockable rhythm, K^(+) level and the ROTEM parameter EXTEM A5 may be useful in predicting ROSC.

Thromboelastography: Current Applications, Future Directions

Analyzing coagulability often hinges on patient surveillance using prothrombin time (PT) or international normalized ratio (INR) and activated partial thromboplastin time (aPTT) to monitor the extrinsic and intrinsic coagulation pathways, respectively A more complete assessment, however, can often be obtained using thromboelastography (TEG), a coagulation assay that evaluates the efficiency of clot formation, as well as the viscoelastic properties of the clot. Developed by Dr. Helmut Hartert in 1948 at the UniversityofHeidelberg, it provides information regarding hemostasis as a dynamic process [1,2]. Here, the TEG technique will be described, as well as its current applications and future directions for its use.

Patient Blood Management in Craniosynostosis Surgery

Background: Craniosynostosis surgery is one of the most hemorrhagic interventions, where transfusion rates vary from 20% to 100% depending on the study. Objective: To describe intraoperative and postoperative outcomes in a secondary analysis of children who underwent craniosynostosis surgery included in the initial retrospective study with the aim of proposing intraoperative implementation optimization protocols for postoperative outcome improvement. Methods: Secondary analysis. The study was approved by the Ethics Committee. Results: There were 69 children with a median age of 10 [0 - 207] months. Eight (11.6%) patients had intraoperative and/or postoperative complications. One patient (1.5%) had intraoperative hemorrhagic shock, and two patients (2.9%) had intraoperative broncholaryngospasm. One patient (1.5%) had postoperative anaphylaxis. One patient (1.5%) had postoperative hemorrhagic shock. One patient (1.5%) had postoperative respiratory failure. Two patients (2.9%) had postoperative neurologic failure. One patient (1.5%) had neuro-meningeal sepsis. One patient (1.5%) had a re-operation. There was no in-hospital mortality. Fourty-eight patients (69.6%) had intraoperative transfusions. Conclusion: Transfusion protocols guided with point-of-care tests should be included in patient blood management programs in craniosynostosis surgery.

Single vs double antiplatelet therapy in acute coronary syndrome: Predictors of bleeding after coronary artery bypass grafting

AIM:To investigate the contribution of anti-platelet therapy and derangements of pre-operative classical coagulation and thromboelastometry parameters to major bleeding post-coronary artery bypass grafting(CABG).METHODS:Two groups of CABG patients were studied:Group A,treated with aspirin alone(n=50),and Group B treated with aspirin and clopidogrel(n=50).Both had similar preoperative,clinical,biologic characteristics and operative management.Classic coagulation parameters and rotational thromboelastometry(ROTEM)profiles were determined preoperatively for both groups and the same heparin treatment was administered.ROTEM profiles(INTEM and EXTEM assays)were analyzed,both for traditional parameters,and thrombin generation potential,expressed by area-under-curve(AUC).RESULTS:There was no significant difference betweenrates of major bleeding between patients treated with aspirin alone,compared with those treated with aspirin and clopidogrel(12%vs 16%,P=0.77).In the 14 cases of major bleeding,pre-operative classic coagulation and traditional ROTEM parameters were comparable.Conversely we observed that the AUC in the EXTEM test was significantly lower in bleeders(5030±1115 Ohm*min)than non-bleeders(6568±548Ohm*min)(P<0.0001).CONCLUSION:We observed that patients with a low AUC value were at a significantly higher risk of bleeding compared to patients with higher AUC,regardless of antiplatelet treatment.This suggests that thrombin generation potential,irrespective of the degree of platelet inhibition,correlates with surgical bleeding.