Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California.
J Reconstr Microsurg. 2021 Nov;37(9):774-782. doi: 10.1055/s-0041-1727190. Epub 2021 May 19.
Early detection of thrombotic events is of paramount importance for microsurgical procedures. Here, we present findings that underscore the value of rotational thromboelastometry (ROTEM) to aid in decision-making for pre- and postoperative anticoagulation, as well for patients with suspected hypercoagulability.
We prospectively collected pre- and postoperative ROTEM values on all free flap cases at the University of California, San Francisco, from 2015 to 2016. Patient age, body mass index, comorbidities, operative reports, risk factors, thrombotic complications, and outcomes were collected from electronic medical records. Two-sample -tests were used to compare ROTEM values between cohorts. Modeling for sensitivity, specificity, and accuracy was done for threshold fibrinogen-to-platelet ratio (FPR).
Of 52 patients who underwent free-tissue transfer, 15 had a thrombotic event either intraoperatively or postoperatively that required revision of the vascular anastomosis. Eight patients were clinically hypercoagulable preoperatively, seven of which had a thrombotic event. Several pre- and postoperative ROTEM values differed significantly between thrombotic and nonthrombotic cases. Preoperative ( = 0.027) and postoperative ( = 0.013) FPR were statistically significant when comparing the thrombotic to the nonthrombotic cohort. Threshold FPR ≥ 30 was the most sensitive and FPR ≥ 40 was the most specific.
Our study affirms other studies that established ROTEM as an effective predictive tool for thrombotic events during free-tissue transfer. However, a lower threshold for FPR improves catchment of thrombotic events and flap failure with acceptable sensitivity. Our results support the routine use of ROTEM for detecting hypercoagulability in patients who would potentially benefit from intervention to prevent thrombotic complications.
早期发现血栓事件对于显微外科手术至关重要。在这里，我们提供的研究结果强调了旋转血栓弹性测定（ROTEM）在术前和术后抗凝决策中的价值，以及在疑似高凝状态患者中的价值。
我们前瞻性地收集了 2015 年至 2016 年期间加利福尼亚大学旧金山分校所有游离皮瓣病例的术前和术后 ROTEM 值。从电子病历中收集患者年龄、体重指数、合并症、手术报告、危险因素、血栓并发症和结局。使用两样本 t 检验比较队列之间的 ROTEM 值。对纤维蛋白原-血小板比值（FPR）阈值的灵敏度、特异性和准确性进行建模。
在 52 例行游离组织移植的患者中，有 15 例在手术过程中或手术后发生血栓事件，需要对血管吻合口进行修正。8 例患者术前存在临床高凝状态，其中 7 例发生血栓事件。血栓形成病例与非血栓形成病例之间的几个术前和术后 ROTEM 值差异显著。与非血栓形成队列相比，术前（= 0.027）和术后（= 0.013）FPR 具有统计学意义。当 FPR≥30 时，灵敏度最高，当 FPR≥40 时，特异性最高。
我们的研究证实了其他研究，即 ROTEM 是游离组织移植期间血栓形成事件的有效预测工具。然而，降低 FPR 阈值可以提高血栓事件和皮瓣失败的检出率，同时保持可接受的灵敏度。我们的研究结果支持常规使用 ROTEM 检测可能受益于干预以预防血栓并发症的高凝患者。
