ROTEM® thrombelastometry in on-pump cardiac surgery patients
Bibliographic record
Abstract
On-pump cardiac surgery is frequently associated with intraoperative and postoperative bleeding. ROTEM is a point-of-care method that reflects more closely than classical coagulation tests the in vivo haemostatic activity and the contribution of fibrinogen and platelets to clot formation. Two hundred and thirty-two patients (age 67 ± 10 years) with elective cardiac surgery and an on-pump time >45 minutes (mean 112 ± 52 min) were enrolled. Preoperative, intraoperative and postoperative blood samples were taken from an arterial catheter. The ROTEM system and test kits (INTEM/EXTEM = intrinsic/extrinsic activation, FIBTEM = EXTEM with inhibition of platelets) were from Pentapharm (Munich, Germany). The clot formation time (CFT) and maximum clot firmness (MCF), but not clotting time (CT), were strongly correlated with the fibrinogen level and platelet count. Surgery significantly decreased the ROTEM haemostatic activity, but normalised in most patients within 14–18 h postoperation. Lowest haemostatic activity (dramatic increase in CT and CFT, decrease in MCF) was seen when patients were conditioned for cardiopulmonary bypass (CPB). When connected to CPB, the CT and CFT turned to recover, but MCF in EXTEM remained unchanged and MCF in FIBTEM declined further indicating continuous fibrinogen consumption. In 12.5% of our patients, postoperative MCF in FIBTEM was reduced to <9 mm indicating a need for fibrinogen substitution. Low postoperative activity in ROTEM was associated with high postoperative blood loss. The positive predictive value and specificity of FIBTEM were clearly superior to those of the APTT or prothrombin time. Up to 50% of patients had an increased haemostatic activity in preoperative ROTEM , and this was associated with high CRP levels and intraoperative blood loss. ROTEM is a valuable tool to monitor perioperative haemostasis. The decreases in haemostatic activity and postoperative bleeding are probably due to anticoagulant therapy as well as fibrinogen and platelet consumption. An increased preoperative haemostatic activity is probably due to an acute phase reaction associated with advanced atherosclerosis, and the high intraoperative bleeding in these patients might be due to the atherosclerotic vessels rather than due to an insufficient haemostasis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".