Abstract
Background/Aims Rotational thromboelastometry (ROTEM) is a viscoelastic test that is used in patients
with liver disease for guiding blood component use. This study is aimed at comparing
the amount of blood products transfused and bleeding rates in patients without liver
disease, who underwent therapeutic endoscopic procedures with deranged screening coagulation
tests (prothrombin time [PT]; activated partial thromboplastin time [aPTT]), with
and without hypocoagulable ROTEM.
Methods Patients with deranged PT and aPTT without liver disease who underwent therapeutic
endoscopic interventions during the period 2020 to 2022 were retrospectively analyzed.
Baseline parameters, amount of blood products transfused, and outcomes such as 30-day
bleeding and mortality rates were recorded in those with and without hypocoagulable
ROTEM.
Results Of the 204 patients with deranged PT/aPTT who underwent therapeutic endoscopy during
the study period, 180 of those with liver disease were excluded. Six patients (M:F = 5:1;
median age: 37, 20–54 years) had hypocoagulable ROTEM and 18 patients (M:F = 11:7;
median age: 56, 20–71 years) had normo-/hypercoagulable ROTEM. There were significant
differences in the total amount of fresh frozen plasma (FFP) transfused and FFP transfused
per patient between the two groups (9,000 vs. 4,500 mL and 2,000 vs. 1,000 mL; p = 0.04, respectively). Two patients with hypocoagulable ROTEM bled within 30 days,
while none did in the comparator group (p = 0.03). One patient in the hypocoagulable group died within 30 days and none in
the normo-/hypercoagulable group.
Conclusion The use of ROTEM reduces FFP requirement in patients without liver disease with deranged
PT/aPTT undergoing therapeutic endoscopic procedures without any increased risk of
early or late rebleeding, and 30-day mortality.
Keywords fresh frozen plasma - rebleeding - screening coagulation tests - therapeutic endoscopic
procedures - thromboelastometry
