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Semin Thromb Hemost 2023; 49(02): 134-144
DOI: 10.1055/s-0042-1753510
Review Article

Rotational Thromboelastometry Predicts Transfusion Requirements in Total Joint Arthroplasties

Andreas G. Tsantes    *
1   Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
,
Dimitrios V. Papadopoulos   *
2   Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
,
Anastasios G. Roustemis
3   First Department of Orthopaedics, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
,
Ioannis G. Trikoupis
3   First Department of Orthopaedics, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
,
Daniele Piovani
4   Department of Biomedical Sciences, Humanitas University, Milan, Italy
5   IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Konstantina A. Tsante
1   Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
,
Petros G. Mantzios
1   Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
,
Andreas F. Mavrogenis
3   First Department of Orthopaedics, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
,
Rozeta Sokou 
1   Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
,
Styliani I. Kokoris
1   Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
,
Anastasios G. Kriebardis
6   Department of Biomedical Science, Laboratory of Reliability and Quality Control in Laboratory Hematology, School of Health and Caring Science, University of West Attica, Athens, Greece
,
Panayiotis J. Papagelopoulos
1   Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
,
Stefanos Bonovas
4   Department of Biomedical Sciences, Humanitas University, Milan, Italy
5   IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Argirios E. Tsantes
1   Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Abstract

The frequency of red blood cell (RBC) transfusions is high in total joint arthroplasties, and the hemorrhagic risk is associated with both surgery- and patient-related factors. This study aims to assess the ability of rotational thromboelastometry (ROTEM) to identify patients at high risk for transfusion and excessive bleeding. A prospective observational study was conducted including 206 patients who underwent total knee or hip arthroplasties. Assessment of the coagulation status was performed preoperatively and immediately postoperatively using ROTEM analysis and conventional coagulation tests. The number of RBC transfusions and the postoperative hemoglobin drop were recorded. ROTEM findings were compared between transfused and nontransfused patients, and also between patients with and without excessive bleeding. Higher values of postoperative FIBTEM maximum clot firmness (MCF) were associated with lower risks of transfusion (odds ration [OR]: 0.66, 95% confidence interval [CI]: 0.57–0.78, p<0.001) and excessive bleeding (OR: 0.58, 95% CI: 0.36–0.94, p=0.028). A postoperative FIBTEM MCF value ≤10mm had 80.1% (95% CI: 73.1–85.9%) sensitivity with 75.5% (95% CI: 60.4–87.1%) specificity to predict transfusion requirements, and 70.5% (95% CI: 63.6–76.8%) sensitivity with 88.8% (95% CI: 51.7–99.7%) specificity to predict excessive bleeding. The estimated average probability of transfusion in patients with FIBTEM MCF values of 0 to 4mm is 86.3%. ROTEM assay demonstrated high predictive ability for transfusion and excessive bleeding. Identification of patients at risk for transfusion could allow blood banks to ensure adequate blood supply, while also more intense blood-salvaging strategies could be implemented in these patients.

Keywords

bleeding risk - coagulopathy - joint replacements - rotational thromboelastometry - transfusion

* Both authors have equal contribution.


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Publication History

Article published online:
02 September 2022

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