Stellenwert der Thrombelastometrie für das Monitoring von Faktor XIII

Summary

Recently published studies give evidence, that an increased maximum lysis in the APTEM^® – test (ML₆₀ > 12%) of the ROTEM^® (Tem International GmbH, Munich, Germany) might indicate a factor XIII deficiency (FXIII < 70%). It was the aim of this study to investigate the feasibility of thrombelastometric measurements with the ROTEM device to reflect the isolated influence of FXIII on clot stability and therefore to indicate potential factor XIII deficiencies. Patients, method: After approval by the local Scientific and Ethic Review Board, 26 consecutive patients, scheduled for elective craniotomy for tumour resection, were prospectively enrolled into this study. Blood samples were taken for conventional laboratory coagulation analyses, FXIII analyses and thrombelastometric measurements (EXTEM, FIBTEM and APTEM tests) after induction of general anaesthesia (T1), before skin incision (T2) as well as at (T3) and 24 hours after (T4) postoperative admission to ICU, respectively. Statistical analyses included Spearman rank order correlations and multiple linear regressions. Results: FXIII concentrations did not correlate with the ML₆₀ in the APTEM test at any measuring point. Neither platelet count nor fibrinogen nor FXIII concentrations were of predictive value for ML₆₀ of the APTEM test. Conclusion: The results lead to the assumption that thrombelastometric measurements may not be appropriate for the perioperative monitoring of FXIII concentration.

Zusammenfassung

Unlängst publizierte Untersuchungen legen nahe, dass eine erhöhte maximale Lyse im APTEM-Test^® (ML₆₀ > 12%) des ROTEM^® (TEM International GmbH, München) ein FXIII-Defizit (FXIII < 70%) anzeigen könnte. Ziel: In dieser Studie sollte untersucht werden, ob sich thrombelastometrische Messungen mit dem ROTEM eignen, um den isolierten Einfluss von FXIII auf die Gerinnselstabilität wiederzugeben und damit ein potenzielles FXIII-Defizit anzuzeigen. Patienten, Methode: Nach positivem Ethik -votum nahmen 26 Patienten, die sich einer elektiv geplanten Kraniotomie zur Tumorresektion unterzogen, an der Studie teil. Unmittelbar nach Narkoseeinleitung (T1), vor Hautschnitt (T2), bei (T3) und 24 h nach (T4) postoperativer Aufnahme auf die Intensivstation wurden Blutentnahmen für konventionelle Gerinnungsanalysen, FXIII-Einzelfaktoranalysen und thrombelastometrische Untersuchungen mit dem ROTEM (EXTEM-, FIBTEM- und APTEM-Test) entnommen. Zur statistischen Analyse wurden Rangsummenkorrelationen nach Spearman und multiple lineare Regressionsanalysen durchgeführt. Ergebnisse, Schlussfolgerung: Die FXIII-Konzentrationen korrelierten zu keinem Messzeitpunkt mit der ML₆₀ im APTEM-Test. Weder Thrombozytenzahl noch Fibrinogen- oder FXIII-Konzentration besaß einen prä-diktiven Wert für die ML₆₀ des APTEM- Tests. Die Ergebnisse dieser Untersuchung sprechen nicht dafür, dass die Thrombelastometrie im gewählten Kollektiv zum perioperativen Monitoring der FXIII-Konzentration geeignet sein könnte.

Keywords

Factor XIII - perioperative coagulopathy - thrombelastometry - ROTEM

Schlüsselwörter

Faktor XIII; perioperative Koagulopathie - Thrombelastometrie - ROTEM

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