Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.
Transfus Apher Sci. 2021 Jun;60(3):103125. doi: 10.1016/j.transci.2021.103125. Epub 2021 Mar 23.
INR is traditionally used as a marker of clinical coagulopathy, but is suboptimal in liver disease patients due to rebalanced hemostasis and its ineffectiveness to predict bleeding. Rotational thromboelastometry (ROTEM) testing evaluates whole blood hemostasis, which may provide more accurate assessments with the EXTEM CT parameter than INR. Thus, in end-stage liver disease (ESLD) patients, we hypothesized that elevated INRs are associated with normal EXTEM CT values.
A retrospective study assessing adult (>18) patients with ESLD and elevated INRs undergoing liver transplantation, was performed to assess correlations between INR and EXTEM CT. This included patients post-ROTEM implementation where all had pre-operative ROTEM testing; and patients up to one year pre-ROTEM implementation to compare transfusion utilization. Data abstracted also included patient demographics, coagulation testing results, liver disease etiology, and MELD score.
The study included 138 patients in the post-ROTEM group and 59 patients in the pre-ROTEM group. Normal EXTEM CT was observed in 95.3 % and 93 % of patients with INR of 1.3-1.8 and up to 3 respectively. There was no correlation between INR of 1.3-1.8 and EXTEM CT (⍴ = 0.239), and only moderate correlation was observed with higher INRs (⍴ = 0.617 with INRs >1.8). ROTEM-guided transfusion in liver transplant surgeries was associated with reduced plasma transfusion (OR 0.27, 95 % CI 0.12-0.58, p = 0.001) after adjusting for red cell utilization and coagulation testing.
Our study suggests ROTEM may be advantageous for evaluating coagulopathy in patients with liver disease and ROTEM-guided transfusion reduces plasma transfusion.
INR 传统上被用作临床凝血功能障碍的标志物，但在肝病患者中并不理想，因为其止血作用重新平衡，且不能有效预测出血。旋转血栓弹性测定（ROTEM）检测评估全血止血功能，与 INR 相比，其 EXTEM CT 参数可能提供更准确的评估。因此，在终末期肝病（ESLD）患者中，我们假设升高的 INR 与正常 EXTEM CT 值相关。
进行了一项回顾性研究，评估了接受肝移植的 ESLD 且 INR 升高的成年（>18 岁）患者，以评估 INR 和 EXTEM CT 之间的相关性。这包括 ROTEM 实施后的患者，他们均接受了术前 ROTEM 检测；以及 ROTEM 实施前一年的患者，用于比较输血利用情况。提取的数据还包括患者的人口统计学、凝血检测结果、肝病病因和 MELD 评分。
研究包括 ROTEM 实施后的 138 例患者和 ROTEM 实施前的 59 例患者。INR 为 1.3-1.8 且高达 3 时，分别有 95.3%和 93%的患者 EXTEM CT 正常。INR 为 1.3-1.8 与 EXTEM CT 之间无相关性（⍴=0.239），而与更高的 INR 相关性仅为中度（⍴=0.617，INR>1.8）。调整红细胞利用和凝血检测后，肝移植手术中 ROTEM 指导输血与减少血浆输血相关（OR 0.27，95%CI 0.12-0.58，p=0.001）。
我们的研究表明，ROTEM 可能有利于评估肝病患者的凝血功能障碍，且 ROTEM 指导输血可减少血浆输血。
