Comparison of arterial versus venous parameters of Rotational thromboelastometry and multiple platelet function analyzer: Results of a pilot study

Abstract

Background. In the operating room and at the ICU, Rotational thromboelastometry (ROTEM^®) and multiple platelet function analyzer (Multiplate^®) are frequently performed on arterial blood samples while known reference ranges refer to venous blood only. To evaluate whether there are clinical important differences between parameters measured in arterial and venous blood, we performed a prospective study in patients undergoing orthopedic surgery. Methods. Arterial and venous blood samples were drawn simultaneously after line insertion (T0), intraoperatively (T1), at the end of surgery (T2) and the INTEM^®, EXTEM^® and FIBTEM^® ROTEM assays, as well as the ASPI^®, ADP^® and TRAP^® assays were performed in arterial and venous samples using the ROTEM^® and the Multiplate^® device, respectively. Results. After informed consent, 52 patients were enrolled and data of 50 patients remained for final analysis. Venous and arterial measurement results correlated significantly with a coefficient of 0.519–0.977. At the three measurement points only a few statistically significant deviations were detected for some of the ROTEM^® and Multiplate^® parameters. The magnitude of differences was small and most likely without clinical relevance. Pathological conditions were detected with similar frequency regardless of the sampling site. Only Multiplate^® TRAP at T0 indicated low platelet aggregation more frequently in venous than in arterial samples (p = 0.0455); however, values were only narrow below reference range. Conclusion. The observed differences between arterial and venous results were within the range of variability of the methods reported for venous blood. Pathological values that might be clinically relevant could be detected at similar rates regardless of the sampling site.

Key Words::

• Blood-coagulation
• measurement techniques
• coagulation
• measurement techniques
• thrombelastography
• platelet function test
• surgery
• orthopaedic

Acknowledgements

During the past five years Petra Innerhofer has received educational grants or honoraria for consulting and lecturing, expenses for travel and hotel accommodations and partial support for conducting studies (without any exertion of influence on her study design, statistics or manuscript preparation) from the following companies: Abbott GmbH (Vienna, Austria), Baxter GmbH (Vienna, Austria), B. Braun Melsungen GmbH (Melsungen, Germany), CSL Behring GmbH (Marburg, Germany), Fresenius Kabi GmbH (Graz, Austria), Novo Nordisk A/S (Bagsvaerd, Denmark), Octapharma AG (Vienna, Austria) and TEM Innovations GmbH (formerly Pentapharm GmbH) (Munich, Germany).

Declaration of interest: All other authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

This purely academic study was conducted without any funding. The consumable needs were provided by TEM International GmbH (formerly Pentapharm GmbH) (Munich, Germany) and Verum Diagnostica GmbH (Munich, Germany).