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Reliability of thromboelastometry for detecting the safe coagulation threshold in patients taking acenocoumarol after elective heart valve replacement.

Abstract：

BACKGROUND:Reversal of anticoagulation can be needed in patients undergoing heart valve surgery. ROTEM® has been correlated with international normalized ratio (INR) in patients on warfarin but not with patients on acenocoumarol. This study investigates the reliability of ROTEM® for detecting INR values below the 1.5 threshold in patients on acenocoumarol therapy. MATERIAL AND METHODS:Patients on oral anticoagulation with acenocoumarol after elective heart valve replacement were prospectively included in the study. INR and the ROTEM® were measured simultaneously. ROTEM® parameters included coagulation time, clot formation time, alpha angle, and maximal clot firmness after tissue factor activation (EXTEM). Concordance between INR and ROTEM® was analyzed by Lin's concordance coefficient (LCC) and the correlation with Spearman's rho. RESULTS:Fifty-four consecutive patients (40 female; median age 67years) were included. Clotting time (CT) was the parameter that best correlated with INR (r=0.81, p<0,001), and LCC was substantial (0.67). CT was able to predict INR values above or below 1.5: area under curve=0.998. CT≥84seconds, corresponding to a cut-off for likelihood ratio (LR+)=5, had a sensitivity and specificity of 100% and 80%, respectively, to detect an INR below 1.5. For the same INR threshold, CT≥84seconds had a predictive positive value of 92.9% and a predictive negative value of 100%. CONCLUSION:Our preliminary results suggest that CT≥84seconds in the EXTEM ROTEM® test is a feasible method for predicting an insufficient reversion of oral anticoagulant therapy in patients taking acenocoumarol after elective heart valve surgery.

journal_name

Thromb Res

journal_title

Thrombosis research

authors

Blasi A,Muñoz G,de Soto I,Mellado R,Taura P,Rios J,Balust J,Beltran J

doi

10.1016/j.thromres.2015.07.003

subject

Has Abstract

pub_date

2015-09-01 00:00:00

pages

669-72

issue

3

eissn

0049-3848

issn

1879-2472

pii

S0049-3848(15)30054-2

journal_volume

136

pub_type

临床试验,杂志文章

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