Influence of temperature on thromboelastometry and platelet aggregation in cardiac arrest patients undergoing targeted temperature managementReportar como inadecuado

Influence of temperature on thromboelastometry and platelet aggregation in cardiac arrest patients undergoing targeted temperature management - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Critical Care

, 20:118

First Online: 30 April 2016Received: 21 December 2015Accepted: 19 April 2016


BackgroundCoagulation can be visualised using whole blood coagulation analyses such as thromboelastometry and platelet aggregation tests; however, the role of temperature in the analyses is ambiguous. The aim was to examine whether temperature influences the whole blood coagulation tests.

MethodsWe included 40 patients treated with targeted temperature management 33 ± 1 °C after out-of-hospital cardiac arrest. The blood samples were obtained on hypothermia and normothermia. Each blood sample was analysed simultaneously at 33 °C and 37 °C by thromboelastography ROTEM® employing the assays EXTEM®, INTEM®, FIBTEM® and HEPTEM®, and by Multiplate®Analyzer, using COLtest®, ADPtest®, ASPItest® and TRAPtest® as agonists. Data on antithrombotic drugs were collected systematically from medical records, and data were analysed using repeated measurement analysis of variance ANOVA.

ResultsThe ROTEM® analyses showed increased clotting time, lower maximum velocity and increased time to maximum velocity all p values <0.02 when performed at 33 °C compared with 37 °C, irrespective of the patients being hypothermic median 33.1 °C or normothermic median 37.5 °C. However, EXTEM® time to maximum velocity showed no difference between the analyses performed at 33 °C and 37 °C when the patients were hypothermic p = 0.83. No differences were found in maximum clot firmness all p values >0.09 analysed at 33 °C and 37 °C, independent of the body temperature.

In the hypothermic blood sample, no difference was found when using the COLtest®, ASPItest® or TRAPtest® to compare platelet aggregation analysed at 33 °C and 37 °C all p values >0.19, but platelet aggregation was significantly higher using the ADPtest® p < 0.001 when analysed at 33 °C. In the normothermic blood sample, the TRAPtest® showed no difference p = 0.73 when performed at 33 °C; however, significantly lower aggregation was found using the COLtest® and ASPItest® all p values <0.001, while a higher aggregation at 33 °C was found using the ADPtest® p = 0.003.

ConclusionROTEM® analyses seemed not to be dependent on body temperature but showed a slower initiation of coagulation when analysed at 33 °C compared with 37 °C. The Multiplate®Analyzer results were dependent on the temperature used in the analyses and the body temperature. In whole blood coagulation tests, the temperature used in the analyses should be kept at 37 °C irrespective of the patient’s body temperature being 33 °C or 37 °C.

KeywordsCoagulation Heart arrest Haemostasis Hypothermia Platelet function test Thromboelastometry AbbreviationsADP inhibitorsadenosine diphosphate receptor inhibitors

ANOVAanalysis of variance

AUAggregation units

AUCarea under the curve

CIconfidence intervals

CRPC-reactive protein

INRinternational normalised ratio

LMWHlow molecular weight heparin

ROSCreturn of spontaneous circulation

Download fulltext PDF

Autor: Anni Nørgaard Jeppesen - Hans Kirkegaard - Susanne Ilkjær - Anne Mette Hvas


Documentos relacionados