Assar Mazen, Nilius Henning, Kearn Natalie, Hopman Wilma, Nagler Michael, Othman Maha
Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada.
Division of Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Int J Lab Hematol. 2025 Jun;47(3):520-528. doi: 10.1111/ijlh.14443. Epub 2025 Feb 20.
Thrombophilia, a blood coagulation disorder, poses risks of venous thromboembolism (VTE). Coagulation assays may not be sufficient to assess VTE risk and global assays such as Rotational Thromboelastometry (ROTEM) may add valuable information. We investigated ROTEM's capacity to detect hypercoagulability in patients undergoing thrombophilia screening, its potential impact on patient outcomes, and limitations.
Comprehensive clinical, laboratory, genetic tests, and ROTEM (EXTEM and INTEM) were conducted for 356 patients referred for thrombophilia screening at an academic hospital outpatient unit. Hypercoagulability was identified as a shorter clot formation time (CFT), larger alpha angle (AA), and greater maximum clot firmness (MCF), and was compared in patients with and without VTE. Statistically this was analyzed using Mann-Whitney U and Chi-square tests with p < 0.05 considered significant.
Among 356 patients, 64.6% had previous VTE, with 76.9% experiencing one event, 14.3% recurrent (35.6% unprovoked, 64.4% provoked). 22.5% of patients were on anticoagulation. Those with VTE history exhibited significant alterations in EXTEM and INTEM parameters compared to those without (p < 0.001), showing decreased CFT and increased AA and MCF. However, receiver operating characteristic curves for these variables indicated that none were able to discriminate between those individuals with and without thromboembolic complications.
ROTEM does not appear to be a strong discriminatory test. However, it can detect hypercoagulopathy in patients referred for thrombophilia screening. Abnormal ROTEM may indicate a higher risk for recurrence. However, this can only be determined in prospective cohort studies.
血栓形成倾向是一种凝血障碍，会带来静脉血栓栓塞（VTE）风险。凝血检测可能不足以评估VTE风险，而诸如旋转血栓弹力图（ROTEM）等整体检测可能会提供有价值的信息。我们研究了ROTEM在接受血栓形成倾向筛查的患者中检测高凝状态的能力、其对患者预后的潜在影响以及局限性。
对一家学术医院门诊接受血栓形成倾向筛查的356例患者进行了全面的临床、实验室、基因检测以及ROTEM（EXTEM和INTEM）检测。高凝状态被定义为较短的凝血形成时间（CFT）、较大的α角（AA）和较高的最大凝血硬度（MCF），并在有和没有VTE的患者中进行比较。统计学上使用Mann-Whitney U检验和卡方检验进行分析，p < 0.05被认为具有统计学意义。
在356例患者中，64.6%曾有VTE，其中76.9%经历过一次事件，14.3%复发（35.6%为无诱因，64.4%为有诱因）。22.5%的患者正在接受抗凝治疗。与没有VTE病史的患者相比，有VTE病史的患者在EXTEM和INTEM参数上表现出显著变化（p < 0.001），表现为CFT降低，AA和MCF增加。然而，这些变量的受试者工作特征曲线表明，没有一个能够区分有和没有血栓栓塞并发症的个体。
ROTEM似乎不是一个强有力的鉴别检测方法。然而，它可以在接受血栓形成倾向筛查的患者中检测到高凝状态。ROTEM异常可能表明复发风险较高。然而，这只能在前瞻性队列研究中确定。
