Rotational thromboelastometry (ROTEM) predicts future bleeding events in patients with cirrhosis, according to Melbourne-based research.
In one of the top-ranked posters of merit at Australian Gastroenterology Week 2023, gastroenterologist Dr Natasha Janko from Alfred Health presented results from a prospective study of 162 patients who underwent ROTEM analysis and were followed for any bleeding or thrombotic events.
The study reported that 19 patients experienced a bleeding event within one year of ROTEM.
A univariate analysis found maximum clot firmness using both the EXTEM and INTEM tests was significantly reduced in patients who had a bleeding event compared to those who did not (p<0.01 for both).
As well, clotting time in the INTEM test was prolonged in the group of patients with a bleeding event (p=0.01).
However on multivariate analysis, only maximum clot firmness using EXTEM remained a significant predictor of a bleeding event.
Dr Janko told the limbic that ROTEM was routinely used in active bleeding situations such as postpartum haemorrhage, trauma surgery, cardiac surgery and liver transplant surgery.
“It’s a global haemostatic assay that can be performed at point-of-care really quickly. It allows you to identify which part of the haemostatic pathway is not working and then the treatment for it. How we’re using it is quite different from that. We’re using it in people who aren’t actively bleeding to try and predict bleeding.”
“In liver disease, you get a number of alternations in the haemostatic system and the blood tests we use routinely such as platelet count, INR and fibrinogen only measure one component of the pathway.”