Comparison of two viscoelastic testing devices in a porcine model of surgery, hemorrhage and resuscitation.

INTRODUCTION

Viscoelastic hemostatic assays (VHA) are integral in contemporary hemostatic resuscitation, offering insights into clot formation, firmness, and lysis for rapid diagnosis and targeted therapy. Large animal models, particularly swine, provide anatomical and physiological analogies for coagulation research. Despite the growing use of VHAs, the ClotPro device's applicability in porcine models remains unexplored. This study investigates ClotPro in a porcine model of abdominal surgery, severe hemorrhage, and resuscitation, comparing it with the established ROTEM delta system.

METHODS

Twenty-seven healthy pigs underwent abdominal surgery, hemorrhage and resuscitation. ClotPro and ROTEM were used to assess viscoelastic hemostatic properties at baseline, after surgery, 60 min after shock induction, 60 and 120 min after resuscitation.

RESULTS

Clotting times in extrinsically and intrinsically stimulated assays exhibited fair to moderate correlation. Clot firmness in extrinsically stimulated tests could be used interchangeably while fibrin polymerization assays revealed significant differences between the devices. Fibrin polymerization assays in ClotPro consistently yielded higher values than ROTEM. Furthermore, the study evaluated the ClotPro TPA-test's applicability in porcine blood, revealing failure of lysis induction in porcine blood samples.

CONCLUSION

This research contributes valuable insights into the use of ClotPro in porcine models of hemorrhage and coagulopathy, highlighting both its applicability and limitations in comparison to ROTEM delta. The observed differences, especially in fibrin polymerization assays, emphasize the importance of understanding device-specific characteristics when interpreting results. Due to its inapplicability, TPA-test should not be used in porcine blood to evaluate fibrinolytic potential. The study provides a foundation for future investigations into the use of different viscoelastic hemostatic assays in porcine animal models.