Figure 1: Rotational thromboelastometry (ROTEM) assays in postcardiopulmonary bypass period.
Post-CPB INTEM, EXTEM, and APTEM post-CPB show an intense reduction in α-angle (52°) and profound prolongations in CFT (248 s) in INTEM (reference values 70–83° and 30–110 s, respectively); an intense reduction in the α-angles (49° and 24°) and prolongation of CFT (246 and 637 s) in EXTEM and APTEM (reference values 63–83° and 34–159 s, respectively); intense reductions in A10 (31, 33, 19 mm) and A20 (34, 36,28 mm) in INTEM, EXTEM, and APTEM (reference values 44–46 mm and 50–71 mm, 43–65 mm and 50–72 mm, and 43–65 mm and 50–72 mm, respectively); and aggressively decreased maximum clot formation (MCF) 3 mm in FIBTEM (reference value >7 mm). Dramatic reductions of amplitudes (tails) in INTEM and EXTEM and suggesting hyperfibrinolysis with a slight deficiency of clotting factor, hypofibrinogemia, and thrombocytopenia were noted beyond 20 min after starting the ROTEM assays. An abrupt reduction of clot lysis indices at 30 min (CLI30) in INTEM and EXTEM (60% and 65%; reference value 94–100%) and their further profound worsening at 45 min (CLI45) in INTEM and EXTEM (0% and 12%; reference value 94–100%) were also noted.
Post-CPB: immediately after weaning from cardiopulmonary bypass and protamine administration; α-angle: tangent of the slope between 2 and 20 mm, CFT: clot formation time; A10 and A20: amplitudes 10 min and 20 min after the start of the assay; MCF: maximum clot firmness; CLI30 and CLI45: clot lysis indices (% of clot strength) remaining 30min and 45 min after clotting time.
Post-CPB INTEM, EXTEM, and APTEM post-CPB show an intense reduction in α-angle (52°) and profound prolongations in CFT (248 s) in INTEM (reference values 70–83° and 30–110 s, respectively); an intense reduction in the α-angles (49° and 24°) and prolongation of CFT (246 and 637 s) in EXTEM and APTEM (reference values 63–83° and 34–159 s, respectively); intense reductions in A10 (31, 33, 19 mm) and A20 (34, 36,28 mm) in INTEM, EXTEM, and APTEM (reference values 44–46 mm and 50–71 mm, 43–65 mm and 50–72 mm, and 43–65 mm and 50–72 mm, respectively); and aggressively decreased maximum clot formation (MCF) 3 mm in FIBTEM (reference value >7 mm). Dramatic reductions of amplitudes (tails) in INTEM and EXTEM and suggesting hyperfibrinolysis with a slight deficiency of clotting factor, hypofibrinogemia, and thrombocytopenia were noted beyond 20 min after starting the ROTEM assays. An abrupt reduction of clot lysis indices at 30 min (CLI30) in INTEM and EXTEM (60% and 65%; reference value 94–100%) and their further profound worsening at 45 min (CLI45) in INTEM and EXTEM (0% and 12%; reference value 94–100%) were also noted.
Post-CPB: immediately after weaning from cardiopulmonary bypass and protamine administration; α-angle: tangent of the slope between 2 and 20 mm, CFT: clot formation time; A10 and A20: amplitudes 10 min and 20 min after the start of the assay; MCF: maximum clot firmness; CLI30 and CLI45: clot lysis indices (% of clot strength) remaining 30min and 45 min after clotting time.
