Department of Anaesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Br J Anaesth. 2014 Feb;112(2):290-7. doi: 10.1093/bja/aet325. Epub 2013 Sep 24.
Early detection of coagulopathy is important to prevent bleeding during liver transplantation (LT). Rotation thromboelastometry (ROTEM(®)) provides the earliest parameter of clot amplitudes at 5 min (A5). We evaluated whether A5 correlates with platelet count (PLT) and fibrinogen concentration (Fib) and can predict thrombocytopenia and hypofibrinogenaemia in hypocoagulable patients undergoing living-donor LT (LDLT).
A total of 3446 retrospective ROTEM(®) measurements, including 1139 EXTEM, 1182 INTEM, and 1125 FIBTEM, with simultaneously measured PLT and Fib, were analysed during LDLT in 239 patients. The correlations between A5 and maximum clot firmness (MCF) index, PLT, and Fib were calculated. Receiver operating characteristic analysis with area under the curve (AUC) was used to assess A5 thresholds predictive of PLT and Fib.
The median PLT was 47 000 mm(-3) and the median Fib was 100 mg dl(-1) during LDLT. The A5 parameters of EXTEM (A5EXTEM) and INTEM (A5INTEM) were highly correlated with MCF (r=0.96 and r=0.95, respectively), PLT (r=0.76 and r=0.77, respectively), and Fib (r=0.63 and r=0.64, respectively). A5 of FIBTEM (A5FIBTEM) was also correlated with MCF (r=0.91) and Fib (r=0.75). A5EXTEM thresholds of 15 and 19 mm predicted PLT<30 000 mm(-3) (AUC=0.90) and <50 000 mm(-3) (AUC=0.87), respectively, whereas A5FIBTEM 4 mm predicted Fib<100 mg dl(-1) (AUC=0.86). Biases from A5EXTEM and A5FIBTEM to their MCFs were 16.4 and 1.3 mm, respectively.
A5 as an early variable of clot firmness is effective in detecting critically low PLT and Fib. A5 can therefore be a reliable fast index guiding transfusion therapy in hypocoagulable patients undergoing LDLT.
早期发现凝血功能障碍对于预防肝移植（LT）期间出血非常重要。旋转血栓弹性测定法（ROTEM(®)）可在 5 分钟时提供最早的血凝块幅度参数 A5。我们评估 A5 是否与血小板计数（PLT）和纤维蛋白原浓度（Fib）相关，并能否预测低凝血患者在活体供肝 LT（LDLT）中发生血小板减少症和低纤维蛋白血症。
对 239 例 LDLT 期间的 3446 次 ROTEM(®)测量结果（包括 1139 次 EXTEM、1182 次 INTEM 和 1125 次 FIBTEM）进行回顾性分析，同时测量 PLT 和 Fib。计算 A5 与最大血凝块硬度（MCF）指数、PLT 和 Fib 之间的相关性。采用曲线下面积（AUC）的受试者工作特征分析来评估预测 PLT 和 Fib 的 A5 阈值。
LDLT 期间，PLT 的中位数为 47000/mm(3)，Fib 的中位数为 100mg/dl(1)。EXTEM（A5EXTEM）和 INTEM（A5INTEM）的 A5 参数与 MCF（r=0.96 和 r=0.95）、PLT（r=0.76 和 r=0.77）和 Fib（r=0.63 和 r=0.64）高度相关。FIBTEM（A5FIBTEM）的 A5 也与 MCF（r=0.91）和 Fib（r=0.75）相关。A5EXTEM 阈值为 15 和 19mm 分别预测 PLT<30000/mm(3)（AUC=0.90）和 <50000/mm(3)（AUC=0.87），而 A5FIBTEM 4mm 预测 Fib<100mg/dl(1)（AUC=0.86）。A5EXTEM 和 A5FIBTEM 与其 MCF 之间的偏差分别为 16.4 和 1.3mm。
作为血凝块强度的早期变量，A5 可有效检测血小板严重降低和纤维蛋白原降低。因此，A5 可以成为低凝血患者 LDLT 中指导输血治疗的可靠快速指标。
