J Lee1, K H Wyssusek2, R M N Kimble3, M Way4, A A van Zundert5, J Cohen6, J Rowell7, V A Eley2. 1. Department of Anaesthesia and Perioperative Services, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; The University of Queensland, QLD, Australia. Electronic address: Julie.Lee@health.qld.gov.au. 2. Department of Anaesthesia and Perioperative Services, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; The University of Queensland, QLD, Australia. 3. The University of Queensland, QLD, Australia; Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. 4. QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia. 5. Department of Anaesthesia and Perioperative Services, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; The University of Queensland, QLD, Australia; Queensland University of Technology, Brisbane, QLD, Australia. 6. The University of Queensland, QLD, Australia; Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. 7. The University of Queensland, QLD, Australia; Department of Haematology, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Abstract
BACKGROUND: Rotational thromboelastometry (ROTEM®) is a point-of-care coagulation test. Reference ranges in non-labouring women have recently been established from a cohort of women presenting for elective caesarean delivery using the recommended minimum sample size of 120. This study aimed to present baseline parameters for labouring and non-labouring women and to compare the mean values of these ROTEM® parameters. METHODS: Ethical approval was granted for an opt-out recruitment approach for labouring women and written consent was obtained from non-labouring women (data published previously). ROTEM® testing was performed in these two cohorts at term gestation. Women with any condition affecting coagulation were excluded. ROTEM® Delta reference ranges were derived by calculating the 2.5 and 97.5 percentiles for INTEM/EXTEM/FIBTEM amplitude at 5 min (A5), coagulation time (CT), maximum clot firmness (MCF) and clot formation time (CFT). RESULTS: One hundred and twenty-one labouring and 132 non-labouring women met inclusion criteria. The mean values for selected ROTEM® parameters for labouring and non-labouring women respectively were: FIBTEM A5, 21.05 and 19.7 mm (P=0.008); EXTEM A5, 54.8 and 53.2 mm (P=0.025); and EXTEM CT, 52.2 and 53.7 s (P=0.049). Significant differences between the groups were observed in measures of clotting onset and clot firmness. CONCLUSIONS: We demonstrated a significant decrease in the mean time-to-clotting onset in labouring women compared with non-labouring women. Mean values for measures of clot firmness were greater in labouring women. In comparison to previously established ROTEM® baseline parameters for non-labouring women, this study provides evidence that there is greater hyper-coagulability in labouring women.
BACKGROUND:Rotational thromboelastometry (ROTEM®) is a point-of-care coagulation test. Reference ranges in non-labouring women have recently been established from a cohort of women presenting for elective caesarean delivery using the recommended minimum sample size of 120. This study aimed to present baseline parameters for labouring and non-labouring women and to compare the mean values of these ROTEM® parameters. METHODS: Ethical approval was granted for an opt-out recruitment approach for labouring women and written consent was obtained from non-labouring women (data published previously). ROTEM® testing was performed in these two cohorts at term gestation. Women with any condition affecting coagulation were excluded. ROTEM® Delta reference ranges were derived by calculating the 2.5 and 97.5 percentiles for INTEM/EXTEM/FIBTEM amplitude at 5 min (A5), coagulation time (CT), maximum clot firmness (MCF) and clot formation time (CFT). RESULTS: One hundred and twenty-one labouring and 132 non-labouring women met inclusion criteria. The mean values for selected ROTEM® parameters for labouring and non-labouring women respectively were: FIBTEM A5, 21.05 and 19.7 mm (P=0.008); EXTEM A5, 54.8 and 53.2 mm (P=0.025); and EXTEM CT, 52.2 and 53.7 s (P=0.049). Significant differences between the groups were observed in measures of clotting onset and clot firmness. CONCLUSIONS: We demonstrated a significant decrease in the mean time-to-clotting onset in labouring women compared with non-labouring women. Mean values for measures of clot firmness were greater in labouring women. In comparison to previously established ROTEM® baseline parameters for non-labouring women, this study provides evidence that there is greater hyper-coagulability in labouring women.
Authors: Lucia Stanciakova; Miroslava Dobrotova; Pavol Holly; Jana Zolkova; Lubica Vadelova; Ingrid Skornova; Jela Ivankova; Tomas Bolek; Matej Samos; Marian Grendar; Jan Danko; Peter Kubisz; Jan Stasko Journal: Diagnostics (Basel) Date: 2021-05-03