Thromboelastometry as a diagnostic tool in mild bleeding disorders: A prospective cohort study.

Wieland Greguare-Sander, Anna; Wuillemin, Walter A; Nagler, Michael (2019). Thromboelastometry as a diagnostic tool in mild bleeding disorders: A prospective cohort study. European journal of anaesthesiology, 36(6), pp. 457-465. Wolters Kluwer 10.1097/EJA.0000000000000985

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BACKGROUND Major guidelines emphasise the potential of visco-elastic methods to overcome the limitations of conventional laboratory assays in the peri-operative setting. Their sensitivity regarding mild bleeding disorders (MBDs), the most common bleeding disorders in the general population, is however unknown. OBJECTIVE The aim of this study was to investigate the sensitivity of thromboelastometry for diagnosis of MBD. DESIGN A single-centre prospective cohort study. SETTING Haematology outpatient unit of a tertiary general hospital in Central Switzerland. PATIENTS All consecutive patients referred over a 32-month period with a suspected bleeding disorder were included and thromboelastometry was conducted using a ROTEM delta (EXTEM, INTEM and FIBTEM). Diagnostic work-up was performed according to current guidelines including the ISTH bleeding assessment tool (ISTH BAT). MAIN OUTCOME MEASURES Distribution of clotting time (CT) and maximum clot firmness (MCF) results in relation to the presence of MBD. RESULTS Two hundred and seventeen patients were assessed; the median [IQR] age was 39 years [28 to 57]; 151 patients were women (70%). MBD was diagnosed in 97 patients (45%), no MBD was found in 100 patients (46%) and a systemic disorder recognised in 20 patients (9%). Presence of MBD was not associated with a significant difference in thromboelastometry variables (0.2 s in CT EXTEM, 95% CI -2.3 to 2.7; -0.2 mm in MCF EXTEM, 95% CI -1.8 to 1.5; -0.7 s in CT INTEM, 95% CI -12.6 to 11.2; 0.6 mm in MCF INTEM, 95% CI -1.2 to 1.3; 0.8 mm in MCF FIBTEM, 95% CI -1.6 to 1.4) and most results were within the established reference ranges. CONCLUSION Our data did not support the use of thromboelastometry as a diagnostic tool in patients with MBD.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Institute of Clinical Chemistry

UniBE Contributor:

Nagler, Michael

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1365-2346

Publisher:

Wolters Kluwer

Language:

English

Submitter:

Pierrette Durand Lüthi

Date Deposited:

17 Sep 2019 09:45

Last Modified:

17 Sep 2019 09:45

Publisher DOI:

10.1097/EJA.0000000000000985

PubMed ID:

30950901

BORIS DOI:

10.7892/boris.133196

URI:

https://boris.unibe.ch/id/eprint/133196

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