Diagnostic value of nonactivated thromboelastometry in obstetric and gynecological practice with a focus on rare coagulopathies

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Abstract

The quality of clinical laboratory tests is characterized by clinical informative value, which is one of the main parameters. Activator tests and nonactivated thromboelastometry (NATEM) are performed with the ROTEM Delta thromboelastometer. Activator tests provide rapid assessment of fibrinogen activity, coagulation factors, fibrinolysis and the effect of heparin on clot formation, which determines their high clinical information value for Point Оf Care evaluation of coagulation and targeted therapy for massive bleeding. NATEM is more commonly used in clinical practice due to its ease of implementation and low cost; however, there is a lack of convincing evidence of its clinical value in identifying the causes of bleeding, particularly in obstetrics and gynecology.

NATEM parameters were shown to have high sensitivity to hypercoagulability and low sensitivity to detect von Willebrand disease, F:VII and F:XII deficiency in patients with obstetric and gynecological coagulopathy. In the presence of lupus anticoagulant, NATEM parameters do not reflect prothrombotic risk, but are instead in the area of hypocoagulation. In hemorrhage, NATEM parameters are multidirectional and fail to differentiate the cause of the hemorrhagic syndrome.

Conclusion: NATEM has low diagnostic value for the detection of coagulopathy in obstetric and gynecological patients. NATEM parameters are highly sensitive to hypercoagulation, which may mask clotting factor deficiency. NATEM does not provide diagnostic evidence of the cause of coagulopathic bleeding; activator tests should be performed for this purpose.

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About the authors

Olga S. Beznoshchenko

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Author for correspondence.
Email: o_beznoshchenko@oparina4.ru
ORCID iD: 0000-0003-4645-8976

PhD, Researcher at the Institute of Anesthesiology, Intensive Care and Transfusiology, clinical laboratory diagnostics doctor at the Department of Anesthesiology and Intensive Care

Russian Federation, Moscow

Tatiana A. Fedorova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: t_fyodorova@oparina4.ru
ORCID iD: 0000-0001-6714-6344

Dr. Med. Sci., Professor, Deputy Director of the Institute of Anesthesiology, Intensive Care and Transfusiology, Head of the Department of Transfusiology and Extracorporeal Hemocorrection

Russian Federation, Moscow

Elena V. Strelnikova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: estrel100@mail.ru
ORCID iD: 0000-0002-6926-8414

PhD, transfusiologist, Department of Extracorporeal Treatment and Detoxification of the Institute of Anesthesiology

Russian Federation, Moscow

Olga A. Parfenova

Patrice Lumumba Peoples’ Friendship University of Russia

Email: parfenony@gmail.com
ORCID iD: 0000-0003-4492-0426

hematologist

Russian Federation, Moscow

Alexey V. Dikov

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: dikov.08@gmail.com
ORCID iD: 0000-0002-2298-1853

anesthesiologist-resuscitator at the Department of Anesthesiology and Intensive Care of the Institute of Anesthesiology

Russian Federation, Moscow

Borislav V. Silaev

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: b_silaev@oparina4.ru
ORCID iD: 0000-0002-9698-3915

PhD, Head of the Department of Anesthesiology and Intensive Care of the Institute of Anesthesiology, Intensive Care and Transfusiology, Associate Professor at the Department of Anesthesiology and Intensive Care, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. NATEM thermograms in dynamics in patient C. with type III Willebrand's disease

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3. 2. Dynamics of hemostasis system parameters and the thrombodynamic potential index (TPI) NATEM in patient C. with type III Willebrand's disease in the prenatal and postpartum period

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4. Fig. 3. NATEM thermograms in dynamics in the girl F. with hereditary deficiency of f-VII

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5. Fig. 4. NATEM thermograms in dynamics in a pregnant woman with Hageman's disease

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6. 5. Temograms of patient P. with hemorrhagic syndrome in the postpartum period. The decrease in clot density (parameters A5, A]0 and A20) in FIBTEM and EXT (Fig. B, C) is due to fibrinogen deficiency and hyperfibrinolysis

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