Can ROTEM Thromboelastometry Predict Postoperative Bleeding After Cardiac Surgery?

Objective: To evaluate the predictive ability of ROTEM thromboelastometry (Pentapharm, Basel, Switzerland) to identify patients bleeding more than 200 mL/h in the early postoperative period after cardiac surgery.

Design: A prospective observational study.

Setting: A single university hospital.

Participants: Fifty-eight adult male and female patients undergoing primary coronary artery revascularization.

Interventions: Blood samples taken preoperatively and at 1, 2, and 3 hours after surgery.

Measurements and Main Results: Eight patients bled at least 200 mL/h in the study period. All (100%) had at least 1 abnormal ROTEM result in the study period. Of the 49 patients not found to be bleeding more than 200 mL/h in any of the first 4 postoperative hours, 46 (94%) had at least 1 abnormal ROTEM result. The positive and negative predictive values were 14.8% and 100%, respectively.

Conclusions: ROTEM thromboelastometry has poor predictive utility to identify patients who bleed more than 200 mL/h in the early postoperative period after cardiac surgery. However, its negative predictive value was good.

Key Words: ROTEM, cardiac surgery, postoperative bleeding