PB1221 - Prospective study comparing Point-of-Care viscoelastic testing and standard laboratory testing for the prediction of bleeding complications in patients after systemic thrombolysis therapy

Tuesday, June 27, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Martin Mirus (he/him/his)

Specialist Intensive Care
University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Department of Anesthesiology and Intensive Care Medicine, Dresden, Saxony, Germany
Dresden, Sachsen, Germany

Co-Author(s)

Lars Heubner, MD

Anesthesiology Resident / post-doc Research Fellow
University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Department of Anesthesiology and Intensive Care Medicine, Dresden, Saxony, Germany
Dresden, Sachsen, Germany
RS

Ralph Schneider

Senior physician
University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Department of Internal Medicine, Dresden, Saxony, Germany
Dresden, Sachsen, Germany
VP

Volker Puetz

Senior physician
University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Department of Neurology, Neurovascular Center, Dresden, Saxony, Germany
Dresden, Sachsen, Germany
SB

Simone Bonin

Specialist Intensive Care
University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Department of Internal Medicine, Dresden, Saxony, Germany
Dresden, Sachsen, Germany
AG

Andreas Güldner

Senior physician
University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Department of Anesthesiology and Intensive Care Medicine, Dresden, Saxony, Germany
Dresden, Sachsen, Germany
TK

Thea Koch

Head of department
University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Department of Anesthesiology and Intensive Care Medicine, Dresden, Saxony, Germany
Dresden, Sachsen, Germany
PS

Peter Spieth

Deputy director
University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Department of Anesthesiology and Intensive Care Medicine, Dresden, Saxony, Germany
Dresden, Sachsen, Germany

Background: Thrombolysis therapy in patients with stroke or pulmonary embolism is associated with bleeding complications which typically occur in up to 9.9% (1,2). Identification of patient with increased risk for bleeding possibly can influence both therapy and outcome. Currently it is not known whether standard labor test (SLT) or viscoelastic point-of-care tests (POC) can help to detect patients prone to bleeding after thrombolysis therapy.

Aims: To evaluate whether POC viscoelastic testing (VET) or SLT can help to identify patient with increased risk for bleeding complications after thrombolysis therapy.

Methods: Patients with need for thrombolysis due to pulmonary embolism or stroke were evaluated with POC VET ClotPro and SLT (INR, aPTT, platelets) before and after therapy at defined time points (baseline, after 2h, 6h, 12h, 24h). Parameters are presented as median. Group comparison were performed using the Mann-Whitney-U-Test in SPSS v 27 (IBM, Inc, Armonk, NY, U.S.). Significance level was set as p< 0.05.

Results: From February 2021 to October 2022, 65 patients were enrolled in this trial, with the indication for thrombolysis therapy in 22 patients for PE and in 43 patients for stroke. Six patients (9 %) presented severe bleeding complications (BARC 3-5) with 3 in each group. Compared to patients without bleedings, patients with bleeding complications had prolonged aPTT (30 vs 60s, p< 0.05), prolonged clotting time (CT) in InTest (160 vs. 363s, p< 0.05), and reduced clot stability in FibTest (A5 10 vs 0mm; A10 10 vs 0mm; MCF 13 vs 0mm, p< 0.05) 2 hours after thrombolysis (Table 1).

Conclusion(s): Delayed recovery of aPTT and ClotPro clotting time in InTest and clot stability in FibTest after thrombolysis therapy may help to identify patients with increased bleeding risk.