Value of Rotational Thromboelastometry and Impedance Aggregometry for Evaluating Coagulation Disorders in Patients With Cyanotic and Nongenetic Congenital Heart Disease.

Pujol, Claudia; Stöckl, Alexander; Mebus, Siegrun; Röschenthaler, Franz; Holdenrieder, Stefan; Ewert, Peter; Nagdyman, Nicole; Neidenbach, Rhoia C; Kaemmerer, Harald

doi:10.1016/j.amjcard.2019.02.031

2019

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Title:: Value of Rotational Thromboelastometry and Impedance Aggregometry for Evaluating Coagulation Disorders in Patients With Cyanotic and Nongenetic Congenital Heart Disease.
Document type:: Article; Journal Article
Author(s):: Pujol, Claudia; Stöckl, Alexander; Mebus, Siegrun; Röschenthaler, Franz; Holdenrieder, Stefan; Ewert, Peter; Nagdyman, Nicole; Neidenbach, Rhoia C; Kaemmerer, Harald
Abstract:: Adults with cyanotic congenital heart diseases (CCHD) have a higher risk for bleeding, but also for thrombosis. Rotational thromboelastometry (RT), using tissue factor (EXTEM), a contact activator (INTEM) or cytochalasin (FIBTEM), assesses coagulation by determining the time to initiation of clotting (CT) and clot firmness (MCF) including platelet-fibrin-interaction. The aim of this study was to evaluate RT and whole blood impedance aggregometry (IA) in CCHD compared with a control group without chronic cyanosis (NCCHD). These were used to establish normal reference ranges. We prospectively included 124 patients (76 CCHD, 48 NCCHD). Mean oxygen saturation in CCHD was 81.5%, and 98% in NCCHD (p <0.001). Fifty-five CCHD and 1 NCCHD had pulmonary hypertension. Eisenmenger syndrome was present in 39 CCHD (51.3%). Hemoglobin, hematocrit, and reticulocyte levels were significantly higher in CCHD, and they also showed more thrombocytopenia. Platelet aggregation was under normal range in 89.5% of CCHD after triggering with ADP, in 85.5% after triggering with arachidonic acid (ASPI) and in 73.7% after TRAP-6. RT showed significantly longer clotting times and reduced clot firmness in both EXTEM and INTEM tests. FIBTEM-MCF was also significantly reduced. Moderate inverse correlation was found between platelet count and erythrocytes (r = -0.608, p <0.001). Significant correlations were found between platelet number and RT-parameters as well as with all IA parameters. In conclusion, according to RT and IA, CCHD present hypocoagulable disorders. No signs of hypercoagulability were found.
Journal title abbreviation:: Am J Cardiol
Year:: 2019
Journal volume:: 123
Journal issue:: 10
Pages contribution:: 1696-1702
Fulltext / DOI:: doi:10.1016/j.amjcard.2019.02.031
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/30885417
Print-ISSN:: 0002-9149
TUM Institution:: Institut für Laboratoriumsmedizin (keine SAP-Zuordnung!); Klinik für Kinderkardiologie und angeborene Herzfehler (Prof. Hess)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Institut für Laboratoriumsmedizin (DHM) (Prof. Holdenrieder)2019

mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Kinderkardiologie und angeborene Herzfehler (DHM) (Prof. Ewert)2019