TITLE:
Mortality and Thromboembolic Events in Hypercoagulable States from Rotational Thromboelastography (ROTEM) in Patients Who Undergo Coronary Bypass Surgery
AUTHORS:
Sira Laohathai, Piya Samankatiwat
KEYWORDS:
Hypercoagulable Stage, CABG, ROTEM
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.9 No.10,
September
29,
2019
ABSTRACT: Purpose: This study is to identify the prevalence of preoperative hypercoagulability
in Thailand high-risk population assessed by Rotational thromboelastography (ROTEM) and
test hypothesis that the pre-surgical ROTEM statuses are related to MACCE
at 1, 12, 60 months after coronary bypass graft surgery (CABG). Method: This is a prospective
cohort in consecutive patients who underwent on-pump CABG between 2013-2015.
Blood samplings were collected and analyzed using ROTEM preoperatively. Hypercoagulable
state was defined as any clotting time (CT) or clot formation time (CFT)
below the lower normal limit or amplitude 10 min after CT (A10), Maximum clot
firmness (MCF) in ROTEM measurement is above the upper normal limit of EXTEM, INTEM and
FIBTEM. Results: 43% of CABG patients who
were diagnosed as hypercoagulability state assessed by ROTEM. Mortality rate was
slightly higher in hypercoagulable patients without statistical significance
(9% vs 5.1%; P = 0.461). However, overall combined uneventful rate was significantly increased in
hypercoagulable patients in 5 years follow-up (27.2% vs 8.6%; P = 0.012). In
univariate analysis, ROTEM hypercoagulability is associated major adverse
cardiovascular and cerebral event (MACCE) in 5-years follow up [OR (95% CI) =
3.975 (1.28 - 12.32); P = 0.017]. Conclusion: Hypercoagulable patients
were identified 43 percent of patients associated with combine uneventful in 5
years follow-up. ROTEM could be applied as a useful tool in the prediction of outcome
after CABG surgery.