Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
J Cardiothorac Vasc Anesth. 2024 Nov;38(11):2552-2558. doi: 10.1053/j.jvca.2024.06.031. Epub 2024 Jun 27.
There is extensive evidence to support the use of FIBTEM to identify hypofibrinogenemia during cardiac surgery, but less to support the use of EXTEM and INTEM clotting times (CTs) to identify other plasmatic coagulation factor deficiencies. The aim of the current study was to assess the diagnostic accuracy of EXTEM, INTEM, and HEPTEM CTs, using laboratory international normalized ratio (INR) and activated partial thromboplastin time (aPTT) as reference standards.
This was a retrospective diagnostic accuracy study.
The work took place at a tertiary referral hospital.
A total of 176 cardiac surgical patients were enrolled.
INR, aPTT, ROTEM EXTEM, INTEM, and HEPTEM were measured post-heparin reversal after cardiopulmonary bypass.
Sensitivity, specificity, and positive (PPVs) and negative predictive values (NPVs) for EXTEM CT >80 seconds and HEPTEM CT >280 seconds to detect INR ≥2.0, and INTEM CT >205 seconds to detect aPTT ≥38.5 seconds were calculated for all patients and the subset with normal FIBTEM A5 (>6 mm). The prevalence of INR ≥2.0 was 13%. EXTEM CT >80 seconds had a sensitivity of 1.00, specificity of 0.25, PPV of 0.17, and NPV of 1.00. HEPTEM CT >280 seconds had a sensitivity of 0.91, specificity of 0.38, PPV of 0.18, and NPV of 0.97. INTEM CT >205 seconds had a sensitivity of 0.97, specificity of 0.11, PPV of 0.57, and NPV of 0.75 for aPTT ≥38.5 seconds. These values were similar for the subset of patients with normal FIBTEM A5.
EXTEM CT >80 seconds and HEPTEM CT >280 seconds have high sensitivities and NPVs for INR >2.0, which would effectively "rule out" INR >2.0 as a cause for excessive bleeding. However, the low specificities and PPVs indicate they would be less effective in ruling it in. INTEM CT >205 seconds had low PPV and NPV in identifying aPTT >38.5 seconds.
有大量证据支持使用 FIBTEM 来识别心脏手术期间的低纤维蛋白原血症，但支持使用 EXTEM 和 INTEM 凝血时间 (CT) 来识别其他血浆凝血因子缺乏症的证据较少。本研究的目的是评估 EXTEM、INTEM 和 HEPTEM CT 的诊断准确性，以实验室国际标准化比值 (INR) 和活化部分凝血活酶时间 (aPTT) 作为参考标准。
这是一项回顾性诊断准确性研究。
工作在一家三级转诊医院进行。
共纳入 176 例心脏手术患者。
在体外循环后肝素逆转后测量 INR、aPTT、ROTEM EXTEM、INTEM 和 HEPTEM。
计算所有患者和纤维蛋白原正常 FIBTEM A5 (>6mm) 亚组中 EXTEM CT >80 秒和 HEPTEM CT >280 秒以检测 INR ≥2.0 以及 INTEM CT >205 秒以检测 aPTT >38.5 秒的灵敏度、特异性和阳性 (PPV) 和阴性预测值 (NPV)。INR ≥2.0 的患病率为 13%。EXTEM CT >80 秒的灵敏度为 1.00，特异性为 0.25，PPV 为 0.17，NPV 为 1.00。HEPTEM CT >280 秒的灵敏度为 0.91，特异性为 0.38，PPV 为 0.18，NPV 为 0.97。INTEM CT >205 秒对 aPTT >38.5 秒的灵敏度为 0.97，特异性为 0.11，PPV 为 0.57，NPV 为 0.75。对于纤维蛋白原正常 FIBTEM A5 的患者亚组，这些值相似。
EXTEM CT >80 秒和 HEPTEM CT >280 秒对 INR >2.0 具有高灵敏度和 NPV，可有效“排除” INR >2.0 为过度出血的原因。然而，低特异性和 PPV 表明它们在确认 INR >2.0 方面的效果较差。INTEM CT >205 秒在识别 aPTT >38.5 秒方面具有较低的 PPV 和 NPV。
