Gruneberg Daniel, Hofer Stefan, Schöchl Herbert, Zipperle Johannes, Oberladstätter Daniel, Decker Sebastian O, Von der Forst Maik, Tourelle Kevin Michel, Dietrich Maximilian, Weigand Markus A, Schmitt Felix C F
Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany.
Department of Anesthesiology, Kaiserslautern Westpfalz Hospital, 67655 Kaiserslautern, Germany.
J Clin Med. 2024 Jan 25;13(3):692. doi: 10.3390/jcm13030692.
: Viscoelastic hemostatic assays (VHAs) have become an integral diagnostic tool in guiding hemostatic therapy, offering new opportunities in personalized hemostatic resuscitation. This study aims to assess the interchangeability of ClotPro® and ROTEM® delta in the unique context of parturient women. : Blood samples from 217 parturient women were collected at three timepoints. A total of 631 data sets were eligible for our final analysis. The clotting times were analyzed via extrinsic and intrinsic assays, and the clot firmness parameters A5, A10, and MCF were analyzed via extrinsic, intrinsic, and fibrin polymerization assays. In parallel, the standard laboratory coagulation statuses were obtained. Device comparison was assessed using regression and Bland-Altman plots. The best cutoff calculations were used to determine the VHA values corresponding to the established standard laboratory cutoffs. : The clotting times in the extrinsic and intrinsic assays showed notable differences between the devices, while the extrinsic and intrinsic clot firmness results demonstrated interchangeability. The fibrinogen assays revealed higher values in ClotPro compared to ROTEM. An ROC analysis identified VHA parameters with high predictive values for coagulopathy exclusion and yet low specificity. : In the obstetric setting, the ROTEM and ClotPro parameters demonstrate a significant variability. Device- and indication-specific transfusion algorithms are essential for the accurate interpretation of measurements and adequate hemostatic therapy.
黏弹性止血检测（VHA）已成为指导止血治疗不可或缺的诊断工具，为个性化止血复苏提供了新机遇。本研究旨在评估在产妇这一独特背景下ClotPro®和ROTEM® delta的互换性。：在三个时间点采集了217名产妇的血样。共有631个数据集符合我们的最终分析要求。通过外源性和内源性检测分析凝血时间，并通过外源性、内源性和纤维蛋白聚合检测分析血凝块硬度参数A5、A10和MCF。同时，获取标准实验室凝血状态。使用回归分析和Bland-Altman图评估设备的可比性。采用最佳截断值计算来确定与既定标准实验室截断值相对应的VHA值。：外源性和内源性检测中的凝血时间在不同设备间存在显著差异，而外源性和内源性血凝块硬度结果显示具有互换性。纤维蛋白原检测显示ClotPro中的值高于ROTEM。ROC分析确定了对排除凝血病具有高预测价值但特异性较低的VHA参数。：在产科环境中，ROTEM和ClotPro参数显示出显著差异。针对设备和适应症的输血算法对于准确解读检测结果和进行充分的止血治疗至关重要。
