The Prognostic Performance of Rotational Thromboelastometry for Excessive Bleeding and Increased Transfusion Requirements in Hip Fracture Surgeries

Andreas G. Tsantes; Dimitrios V. Papadopoulos; Ioannis G. Trikoupis; Konstantina A. Tsante; Andreas F. Mavrogenis; Panagiotis Koulouvaris; Aristeidis G. Vaiopoulos; Daniele Piovani; Georgios K. Nikolopoulos; Styliani I. Kokoris; Stefanos Bonovas; Panayiotis J. Papagelopoulos; Argirios E. Tsantes

doi:10.1055/s-0041-1736617

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2022; 122(06): 895-904
DOI: 10.1055/s-0041-1736617

Coagulation and Fibrinolysis

The Prognostic Performance of Rotational Thromboelastometry for Excessive Bleeding and Increased Transfusion Requirements in Hip Fracture Surgeries

Andreas G. Tsantes ‡^*

¹Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Dimitrios V. Papadopoulos‡^*

²Orthopedic Specialists-UPMC, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

,

Ioannis G. Trikoupis

³First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Konstantina A. Tsante

¹Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Andreas F. Mavrogenis

³First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Panagiotis Koulouvaris

³First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Aristeidis G. Vaiopoulos

¹Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Daniele Piovani

⁴Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

⁵IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

,

Georgios K. Nikolopoulos

⁶Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, University of Cyprus, Nicosia, Cyprus

,

Styliani I. Kokoris

¹Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Stefanos Bonovas

⁴Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

⁵IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

,

Panayiotis J. Papagelopoulos

³First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Argirios E. Tsantes

¹Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

› Institutsangaben

Abstract

Background Hip fracture surgeries are associated with considerable blood loss, while the perioperative coagulopathy is associated with the bleeding risk of these patients. We aimed to evaluate the ability of rotational thromboelastometry (ROTEM) to detect patients at high risk for excessive bleeding and increased transfusion requirements.

Methods We conducted a prospective observational study of 221 patients who underwent hip fracture surgeries. ROTEM analysis was performed preoperatively and immediately postoperatively. Blood loss parameters including blood loss volume, number of transfused red blood cell (RBC) units, and drop in hemoglobin levels were recorded. ROTEM parameters were compared between patients with and without excessive bleeding, and between patients with and without increased transfusion requirements (i.e., ≥2 RBC units).

Results The postoperative FIBTEM MCF value ≤15 mm had 66.6% (95% confidence interval [CI]: 59.7–74.1%) sensitivity and 92.0% (95% CI: 80.7–97.7%) specificity to prognose excessive bleeding, and preoperative FIBTEM MCF value ≤15 mm had 80.4% (95% CI: 73.5–86.2%) sensitivity and 91.2% (95% CI: 80.7–97.0%) specificity to prognose increased transfusion requirements. Preoperative FIBTEM MCF ≤11 mm and postoperative FIBTEM MCF ≤15 mm were associated with considerably increased risks of excessive bleeding (odds ratio [OR]: 44.8, 95% CI: 16.5–121.3, p < 0.001; and OR: 23.0, 95% CI: 7.8–67.0, p < 0.001, respectively).

Conclusion ROTEM parameters demonstrated high prognostic accuracy for excessive bleeding and increased transfusion requirements. This can enable implementation of blood sparing strategies in high-risk patients, while blood banks could be better prepared to ensure adequate blood supply.

Keywords

transfusion - bleeding risk - coagulopathy - rotational thromboelastometry - hip fractures

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