Correlation between thromboelastography and rotational thromboelastometry values in adult liver transplant recipients

Shweta A Singh, Gopi Krishnan, Hashir Ashraf, Rajkumar Subramanian, Vijaykant Pandey, Vaibhav K Nasa, Sumit Goyal, Subhash Gupta, Shweta A Singh, Gopi Krishnan, Hashir Ashraf, Rajkumar Subramanian, Vijaykant Pandey, Vaibhav K Nasa, Sumit Goyal, Subhash Gupta

Abstract

Background and aims: Viscoelastic haemostatic assays (VHA) namely Thromboelastogram (TEG) and Rotational thromboelastometry (ROTEM) are used for global assessment of coagulopathy and guiding transfusion during living donor liver transplant (LDLT).We conducted a study to compare the interchangeability of the values obtained from these devices in patients with End stage liver disease (ESLD) undergoing LDLT.

Methods: In 76 patients undergoing LDLT, ROTEM and TEG were performed and assessed for interchangeability using Spearman Correlation. The direction and strength of correlation between equivalent parameters was calculated using Inter Class Correlation (ICC) and Bland Altman analysis.

Results: The correlation ρ between CT (clotting time) of ROTEM and R of TEG was 0.16 (P = 0.19).The ICC was 0.15, with 95% confidence interval (CI) of -0.38-0.48 (P = 0.25).The ρ of CFT (ROTEM) with K (TEG) was 0.425 (P=<0.001). The ICC was0.49 with 95% CI of 0.17-0.69, P = 0.003.Alpha of ROTEM correlated with Angle of TEG with ρ of 0.475 (P=<0.001). The ICC was 0.61, with 95% CI of 0.36-0.76, P=<0.001.Maximum Clot firmness (MCF) correlated with maximum amplitude (MA) with ρ=0.76 (P=<0.001).The ICC was 0.86, with 95% CI of 0.77-0.92, P=<0.001. Lysis index (L30) of ROTEM correlated clot lysis (CL30) of TEG with ρ of 0.16 (P = 0.18).However, the ICC was 0.45, with 95% CI of 0.11-0.66, P = 0.08. The correlation between CT of ROTEM and R of TEG as well as L30 of ROTEM and CL30 of TEG was not significant.The strongest correlation was found between MCF and MA (P < 0.001). However the MCF/MA showed an agreement of only 86% (ICC = 0.86).

Conclusion: Values from ROTEM and TEG were not found to be interchangeable.

Keywords: Rotational thromboelastometry; thromboelastography; viscoelastic haemostatic assays.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2020 Indian Journal of Anaesthesia.

Figures

Figure 1
Figure 1
Scatter plots of ROTEM vs. TEG parameters (CT/R, CFT/K, Alpha (Rotem)/Angle (TEG), MCF/MA, L30/CL30)
Figure 2
Figure 2
Bland-Altman plots of difference of means and average of ROTEM vs. TEG parameters((a) CT/R, (b) CFT/K, (c) Alpha (Rotem)/Angle (TEG), (d) MCF/MA)

References

    1. Tripodi A, Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med. 2011;365:147–56.
    1. Mallett SV. Clinical utility of viscoelastic tests of coagulation (TEG/ROTEM) in patients with liver disease and during liver transplantation. SeminThrombHemost. 2015;41:527–3.
    1. Clevenger B, Mallett SV. Transfusion and coagulation management in liver transplantation. WJG. 2014;20:6146–58.
    1. Harris LF, Castro-López V, Killard AJ. Coagulation monitoring devices: Past, present, and future at the point of care. Trends Analyt Chem. 2013;50:85–95.
    1. Ganter MT, Hofer CK. Coagulation monitoring: Current techniques and clinical use of viscoelastic point-of-care coagulation devices. AnesthAnalg. 2008;106:1366–75.
    1. Chidananda Swamy MN. Blood transfusion practices in liver transplantation. Indian J Anaesth. 2014;58:647–51.
    1. Wang SC, Shieh JF, Chang KY, Chu YC, Liu CS, Loong CC, et al. Thromboelastography guided transfusion decreases intraoperative blood transfusion during orthotopic liver transplantation: Randomized clinical trial. Transplant Proc. 2010;42:2590–3.
    1. Roullet S, Pillot J, Freyburger G, Biais M, Quinart A, Rault A, et al. Rotation thromboelastometrydetectsthrombocytopenia and hypofibrinogenaemia during orthotopic liver transplantation. Br JAnaesth. 2010;104:422–8.
    1. Wikkelsø A, Wetterslev J, Møller AM, Afshari A. Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding. Cochrane Database Syst Rev. 2016:CD007871.
    1. Da Luz LT, Nascimento B, Shankarakutty AK, Rizoli S, Adhikari NK. Effect of thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®) on diagnosis of coagulopathy, transfusion guidance and mortality in trauma: Descriptive systematic review. Crit Care LondEngl. 2014;18:518.
    1. Wikkelsoe AJ, Afshari A, Wetterslev J, Brok J, Moeller AM. Monitoring patients at risk of massive transfusion with Thrombelastography or Thromboelastometry: A systematic review. Acta Anaesthesiol Scand. 2011;55:1174–89.
    1. Sankarankutty A, Nascimento B, Teodoro da Luz L, Rizoli S. TEG®andROTEM®in trauma: Similar test but different results. World J Emerg Surg. 2012;7:S3.
    1. Coakley M, Reddy K, Mackie I, Mallett S. Transfusion triggers in orthotopic liver transplantation: A comparison of the thromboelastometry analyzer, the thromboelastogram, and conventional coagulation tests. JCardiothoracVascAnesth. 2006;20:548–53.
    1. Sabate A, Dalmau A, Koo M, Aparicio I, Costa M, Contreras L. Coagulopathy management in liver transplantation. Transplant Proc. 2012;44:1523–5.
    1. Tomori T, Hupalo D, Teranishi K, Michaud S, Hammett M, Freilich D, et al. Evaluation of coagulation stages of hemorrhaged swine: Comparison of thromboelastography and rotational elastometry. Blood Coagul Fibrinolysis. 2010;21:20–7.
    1. Hagemo JS, Næss PA, Johansson P, Windeløv NA, Cohen MJ, Røislien J, et al. Evaluation of TEG(®) and ROTEM(®) inter-changeability in trauma patients. Injury. 2013;44:600–5.
    1. Rizoli S, Min A, Sanchez AP, Shek P, Grodecki R, Veigas P, et al. In trauma, conventional ROTEM and TEG results are not interchangeable but are similar in clinical applicability. Mil Med. 2016;181(5 Suppl):117–26.
    1. Jackson GNB, Ashpole KJ, Yentis SM. The TEG vs the ROTEM thromboelastography/thromboelastometry systems. Anaesthesia. 2009;64:212–5.
    1. Kitchen DP, Kitchen S, Jennings I, Woods T, Walker I. Quality assurance and quality control of thrombelastography and rotational Thromboelastometry: The UK NEQAS for blood coagulation experience. SeminThrombHemost. 2010;36:757–63.
    1. Song J-G, Jeong S-M, Jun I-G, Lee H-M, Hwang G-S. Five-minute parameter of thromboelastometry is sufficient todetect thrombocytopenia and hypofibrinogenaemia in patients undergoing liver transplantation. Br J Anaesth. 2014;112:290–7.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅