Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Transfusion. 2012 Jan;52(1):14-22. doi: 10.1111/j.1537-2995.2011.03241.x. Epub 2011 Jul 14.
Coagulopathy after cardiopulmonary bypass (CPB) is caused by multiple perturbations in cellular and humoral elements of coagulation. A timely and comprehensive method to evaluate hemostasis would be helpful in the management of bleeding patients after CPB. The assessment of whole blood coagulation using rotation thromboelastometry (ROTEM) was compared to coagulation tests routinely performed during cardiac surgery.
Blood was obtained from 26 patients undergoing CPB surgery at baseline, at 60 minutes on CPB, at the end of CPB, and on admission to intensive care unit. ROTEM tests (extrinsically activated [EXTEM], intrinsically activated [INTEM], specific clot formation [FIBTEM]), prothrombin time, activated partial thromboplastin time, platelet (PLT) count, fibrinogen, prothrombin level, antithrombin level, and thrombin generation (TG) measurement were performed.
We observed strong correlations between FIBTEM-amplitude at 10 minutes (A10) and fibrinogen level (r=0.87; p<0.001) and between EXTEM/ INTEM-A10 variables and PLT count (r=0.72 and 0.67, respectively; p<0.001). Receiver operating characteristic analysis demonstrated that EXTEM-A10 and INTEM-A10 are predictive of thrombocytopenia below 80×10(9)/L (area under the curve [AUC], 0.83 and 0.82, respectively), and FIBTEM-A10 was highly predictive of fibrinogen level below 200 mg/dL (AUC, 0.96). There were only weak correlations found between TG peak and clot formation time of EXTEM or INTEM (r=0.30 and 0.29, respectively; p<0.05).
ROTEM variables demonstrated clinically relevant correlations with PLT counts and fibrinogen levels. In particular, decreasing levels of fibrinogen can be quickly determined (<15-20 min) using FIBTEM.
体外循环（CPB）后发生的凝血功能紊乱是由细胞和体液凝血成分的多种变化引起的。一种及时和全面的止血评估方法将有助于 CPB 后出血患者的管理。使用旋转血栓弹性描记术（ROTEM）评估全血凝血功能与心脏手术期间常规进行的凝血试验进行了比较。
在基线、CPB 后 60 分钟、CPB 结束时和重症监护病房入院时，从 26 例行 CPB 手术的患者中采集血液。进行 ROTEM 试验（外源性激活[EXTEM]、内源性激活[INTEM]、特定凝块形成[FIBTEM]）、凝血酶原时间、活化部分凝血活酶时间、血小板（PLT）计数、纤维蛋白原、凝血酶原水平、抗凝血酶水平和血栓生成（TG）测量。
我们观察到 FIBTEM-10 分钟振幅（A10）与纤维蛋白原水平之间存在很强的相关性（r=0.87；p<0.001），以及 EXTEM/INTEM-A10 变量与 PLT 计数之间存在很强的相关性（r=0.72 和 0.67，分别；p<0.001）。ROC 分析表明，EXTEM-A10 和 INTEM-A10 可预测血小板计数低于 80×10(9)/L（曲线下面积[AUC]分别为 0.83 和 0.82），FIBTEM-A10 高度预测纤维蛋白原水平低于 200 mg/dL（AUC，0.96）。仅发现 TG 峰值与 EXTEM 或 INTEM 的凝块形成时间之间存在微弱相关性（r=0.30 和 0.29，分别；p<0.05）。
ROTEM 变量与 PLT 计数和纤维蛋白原水平具有临床相关相关性。特别是，使用 FIBTEM 可以快速确定纤维蛋白原水平降低（<15-20 分钟）。
