Mortality and Thromboembolic Events in Hypercoagulable States from Rotational Thromboelastography (ROTEM) in Patients Who Undergo Coronary Bypass Surgery

Abstract

Purpose: This study is to identify the prevalence of preoperative hypercoagulability in Thailand high-risk population assessed by Rotational thromboelastography (ROTEM) and test hypothesis that the pre-surgical ROTEM statuses are related to MACCE at 1, 12, 60 months after coronary bypass graft surgery (CABG). Method: This is a prospective cohort in consecutive patients who underwent on-pump CABG between 2013-2015. Blood samplings were collected and analyzed using ROTEM preoperatively. Hypercoagulable state was defined as any clotting time (CT) or clot formation time (CFT) below the lower normal limit or amplitude 10 min after CT (A10), Maximum clot firmness (MCF) in ROTEM measurement is above the upper normal limit of EXTEM, INTEM and FIBTEM. Results: 43% of CABG patients who were diagnosed as hypercoagulability state assessed by ROTEM. Mortality rate was slightly higher in hypercoagulable patients without statistical significance (9% vs 5.1%; P = 0.461). However, overall combined uneventful rate was significantly increased in hypercoagulable patients in 5 years follow-up (27.2% vs 8.6%; P = 0.012). In univariate analysis, ROTEM hypercoagulability is associated major adverse cardiovascular and cerebral event (MACCE) in 5-years follow up [OR (95% CI) = 3.975 (1.28 - 12.32); P = 0.017]. Conclusion: Hypercoagulable patients were identified 43 percent of patients associated with combine uneventful in 5 years follow-up. ROTEM could be applied as a useful tool in the prediction of outcome after CABG surgery.