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Poster Networking

Acquired and Critical Care Bleeding

PB1008 - Rotational Thromboelastometry (ROTEM) versus Standard Coagulation Tests in Cirrhosis: Is ROTEM more effective in assessing hemostasis rebalance?

Tuesday, June 25, 2024
13:45 – 14:45 ICT
Room: Exhibition Hall

    Presenting Author(s)

  • Nuanrat Cheerasiri, MD

    Lecturer
    Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital
    bangkok, Krung Thep, Thailand

    • Co-Author(s)

  • Ratchaneekorn Jantasing, Bachelor's degree of science (Medical technology)

    Medical technologist
    Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital Bangkok, Thailand
    Bangkok, Krung Thep, Thailand

  • RP

    Rapat Pittayanon

    Associate Professor
    Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital
    Bangkok, Krung Thep, Thailand

  • Ponlapat Rojnuckarin, MD, PhD

    Professor
    Excellence Center in Translational Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
    Bangkok, Krung Thep, Thailand

Background: Periprocedural rotational thromboelastometry (ROTEM), compared with standard coagulation tests (SCTs), could reduce transfusions, while maintaining clinical outcomes in cirrhosis. We hypothesized that the ROTEM and SCT results were correlated. Consequently, the decrease in transfusions using ROTEM might only be from a higher transfusion threshold.

Aims: This cohort study aimed to explore the correlations between ROTEM and SCTs in individuals with cirrhosis.

Methods: In this cohort study, blood specimens from cirrhosis patients undergoing elective upper gastrointestinal endoscopy were subjected to both ROTEM and SCTs. All participants provided informed consent, and the study received ethics committee approval.

Results: There were 133 patients with 57% male and a mean age of 62 (range 32 to 79) years. Additional details are presented in Table 1. High correlations were observed between prothrombin time and EXTEM-CT (r=0.72; 95% Confidence Interval [CI] 0.63 to 0.80, P< 0.001), platelet count and EXTEM-MCF (r=0.70; 95% CI 0.61 to 0.78, P< 0.001), as well as fibrinogen and EXTEM-MCF (r=0.72; 95% CI 0.62 to 0.79, P< 0.001). Hyperfibrinolysis (Shortened ELT) was found in 37.6% of patients but this was undetectable by ROTEM.
Endoscopy revealed that 68 (52%) patients had esophageal varices, 23 (34%) of which underwent band ligation. Among 12 patients exhibiting an INR level exceeding 1.5, only one (8%) received fresh frozen plasma (FFP) transfusion before endoscopy. Within two weeks, no bleeding event occurred in this cohort.

Conclusion(s): In cirrhosis undergoing endoscopy, minimal bleeding risk was identified, even in the presence of abnormal SCTs. A strong correlation exists between PT and EXTEM-CT in cirrhosis, suggesting that FFP infusion may be reduced by just using a higher PT threshold. EXTEM-MCF reflected platelet count and fibrinogen levels, the transfusion thresholds remain to be defined. ROTEM could not detect mild hyperfibrinolysis in a subset of patients, in whom the role of antifibrinolytic agents should be explored.