PB0993 - Thromboelastometry (ROTEM) in detection of hypercoagulability in patients referred for thrombophilia screening

Monday, June 26, 2023

18:30 – 19:30 ET

Room: Exhibition

Co-Author(s)

Mazen Assar, MD

Professor
School of Baccalaureate Nursing, St Lawrence College, Kingston, Ontario, Canada
Kingston, Ontario, Canada

Co-Author(s)

Henning Nilius, MD, MSc (he/him/his)

PhD Student & Resident
Department of Clinical Chemistry, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
Bern, Bern, Switzerland
NK

Natalie Kearn

Undergraduate Student
Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada,
Kingston, Ontario, Canada
WH

Wilma Hopman

Research methodologist and biostatistician
Kingston Health Science Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
Kingston, Ontario, Canada
Michael Nagler, MD, PhD, MSc

Deputy Head
Department of Clinical Chemistry, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
Bern, Bern, Switzerland

Presenting Author(s)

Maha Othman, MD PhD

Professor
Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada,
Kingston, Ontario, Canada

Background: Thrombophilia is a disorder of blood coagulation that can lead to venous thromboembolism (VTE). While conventional coagulation assays may not be sufficient to assess VTE risk, global assays such as ROTEM may add important insights.

Aims: We aimed to examine if ROTEM can detect hypercoagulability in patients referred for thrombophilia screening.

Methods: A total of 376 patients were referred to a specialist outpatient unit for thrombophilia screening at an academic hospital. The average age was 43 ± 17 years with 38.6% (145) males and 61.4% (231) females. 66% (248) had at least one VTE, and 16.5 % (62) had recurrent VTEs. Additionally, 34% had a positive family history, 3.4% (13) had VTE in relation to pregnancy, and 28.6% were obese. In addition to routine thrombophilia testing, ROTEM was performed on blood samples and the coagulation patterns were evaluated using both extrinsic and intrinsic activators (EXTEM and INTEM). Hypercoagulability was identified as a shorter CFT, a larger AA, and a greater MCF. Data were compared between patients with and without previous VTE, using Mann-Whitney U and Chi-square tests, and P < 0.05 was considered significant.

Results: Patients who had a history of VTE demonstrated significant alterations in the coagulation parameters of EXTEM and INTEM (P < 0.001) compared to those without VTE (Table 1). Specifically, a statistically significant decrease in the clotting formation time (CFT), an increase in the alpha angle (AA), and an increase in the maximum clot firmness (MCF) were observed. 84 patients (22.4%) had known thrombophilia traits, while 145 (38.6%) had none (Table 2).

Conclusion(s): Our data suggest that ROTEM parameters, specifically CFT, AA, and MCF can detect hypercoagulopathy in patients referred for thrombophilia screening. Whether this translates into a higher risk for VTE recurrence must be determined in prospective cohort studies.