The Department of Obstetrics and Gynecology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
The Department of Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
Int J Lab Hematol. 2021 Oct;43(5):1216-1224. doi: 10.1111/ijlh.13472. Epub 2021 Jan 25.
Rotational thromboelastometry (ROTEM) rapidly identifies deficits underlying coagulopathy during massive hemorrhage. Prompt coagulopathy correction is balanced with the risk of blood product overutilization, making the ability to quickly target therapy highly desirable. However, data about ROTEM reference ranges in pregnancy are limited. We hypothesized that ROTEM parameters change across trimesters of pregnancy and differ from the nonpregnant state. Also, we sought to identify which hemostatic test best predicts coagulation activation during pregnancy.
A prospective cohort study in healthy pregnant patients in the first (n = 34), second (n = 34), and third trimesters (n = 41) against healthy, nonpregnant controls (n = 33) was performed. Citrated blood was collected, and ROTEM, complete blood count, and plasma-based assays of coagulation were performed. Mean ± SD or median [IQR] were compared across trimesters and between each trimester against the nonpregnant state. ROTEM parameters vs. plasma-based assays were also compared.
Maximum clot firmness and A10 in FIBTEM correlated strongly with fibrinogen level. INTEM and EXTEM values demonstrated only weak to modest correlation with corresponding tests using plasma assays. Thrombin antithrombin complex (TAT) increased from the first trimester onward, whereas other coagulation activation markers did not show difference compared with control group.
Rotational thromboelastometry parameters differ variably across trimesters of pregnancy and compared with the nonpregnant state. The development and use of pregnancy-specific values are critical to the proper clinical interpretation of ROTEM in women with serious hemorrhage during different stages in pregnancy. TAT was the earliest laboratory marker for coagulation activation among others.
旋转血栓弹性测定法（ROTEM）可快速识别大出血期间凝血功能障碍的根本原因。迅速纠正凝血功能障碍与血液制品过度利用的风险相平衡，因此非常需要能够快速靶向治疗的能力。然而，关于妊娠期间 ROTEM 参考范围的数据有限。我们假设 ROTEM 参数在妊娠的各个阶段发生变化，并且与非妊娠状态不同。此外，我们试图确定哪种止血测试最能预测妊娠期间的凝血激活。
对健康孕妇的前瞻性队列研究，分别在第一（n=34）、第二（n=34）和第三（n=41）孕期以及健康非孕妇对照组（n=33）进行。采集枸橼酸盐血液，并进行 ROTEM、全血细胞计数和基于血浆的凝血检测。比较各孕期与非孕期的均值±标准差或中位数[IQR]。还比较了 ROTEM 参数与基于血浆的检测。
纤维蛋白原水平与 FIBTEM 的最大凝块硬度和 A10 密切相关。INTEM 和 EXTEM 值与使用血浆检测的相应检测仅有弱到中度相关性。凝血酶抗凝血酶复合物（TAT）从第一孕期开始增加，而其他凝血激活标志物与对照组相比没有差异。
旋转血栓弹性测定法参数在妊娠各阶段和与非妊娠状态相比有不同程度的差异。制定和使用妊娠特异性值对于正确解读 ROTEM 在妊娠不同阶段严重出血的女性患者的临床结果至关重要。TAT 是其他凝血激活标志物中最早的实验室标志物。
