A prospective study on the correlation between thromboelastometry and standard laboratory tests – influence of type of surgery and perioperative sampling times

Abstract

This prospective study aimed at investigating the influence of surgery type and perioperative sampling times on the correlations between rotational thromboelastometry (ROTEM) parameters and standard laboratory coagulation tests assessing comparable coagulation phases. Patients undergoing glioblastoma multiforme resection (GBR group, n = 60) or laparoscopic colon cancer resection (CCR group, n = 40) were prospectively included. Blood samples for ROTEM and laboratory assessments were consecutively drawn within 24-hours prior to surgery (baseline), and at 2, 24 and 48-hours after surgery. Correlations between perioperative ExTEM clotting-time (CT-exTEM) and prothrombin time (PT), and between FibTEM maximum clot firmness (MCF-fibTEM) with and plasma fibrinogen (pFB) concentration (Clauss method), were evaluated using the Spearman’s rho test. The efficiency of recommended cut-offs of CT-exTEM (>75 s) and MCF-fibTEM (<10 mm) for predicting a prolonged PT (>15 s) or a low pFB (<2 g/L), respectively, was assessed using Receiver-Operator Characteristic curves. Correlations between CT-exTEM and PT were weak in GBR (rho = 0.25 [0.12–0.38], p < .01), and very weak in CCR (rho = 0.06 [−0.12–0.27]). Those between MCF-fibTEM and pFB, were strong in both GBR (rho = 0.69 [0.61–0.76], p < .01) and CCR (rho = 0.70 [0.60–0.78], p < .01). These correlations remained largely unchanged over the studied perioperative period in both groups. Recommended CT-exTEM and MCF-fibTEM cut-offs had poor sensitivity for predicting a prolonged PT (17% [8–31]) or a low pFB (46% [32–62]), without group-related differences. Neither the type of surgery nor the perioperative sampling times had a significant influence on the correlations between ROTEM parameters and standard laboratory tests.

ClinicalTrials.gov ID: NCT02652897

Keywords:

• Cancer
• exTEM
• fibrinogen
• fibTEM
• glioblastoma
• prothrombin time
• ROTEM
• surgery
• VHA

Disclosure statement

None of the authors reports any conflict of interest regarding the content of this paper.

Additional information

Funding

This study has been partially supported by Fondo de Investigación Sanitaria (FIS) PI 15/00512, Instituto de Salud Carlos III, Ministry of Health, Government of Spain, and European Regional Development Fund (ERDF).