A clotting time longer than 226 s in the INTEM channel of the thromboelastometer is an independent risk factor for mortality during bleeding

Background and objective During bleeding the prolongation of the clotting time (CT INTEM ) measured by rotational thromboelastometry (ROTEM) can detect alterations in the intrinsic pathway; however, the significance of a prolonged CT INTEM for risk stratification in patients with bleeding and the treatment with fresh frozen plasma remains unclear. Material and methods A total of 2197 consecutive patients between 2014 and 2020 were retrospectively investigated. All patients were tested by ROTEM during bleeding at the Saarland University Hospital. The CT INTEM values were compared to mortality at 30 days. Discrimination was assessed with C statistic. Adjusted hazard ratios (adjHR, 95% confidence interval, CI) were calculated with multivariable Cox models. Results The results of the C‑statistic showed that CT INTEM (C statistic 0.62, optimal threshold > 226 s) had a predictive power for 30-day mortality. The determined threshold value of CT INTEM > 226 s remained an independent risk predictor for 30-day mortality even after adjustment for confounding factors (adjHR 2.6, 95% CI 2.1–3.2, p < 0.001). The 30-day mortality rate was significantly increased in the group with CT INTEM > 226 s (29% versus 15%, p < 0.001). A multivariable analysis showed that treatment with fresh frozen plasma was not associated with increased 30-day mortality in patients with CT INTEM > 226 s, in contrast to all patients. Conclusion Our results indicate that CT INTEM > 226s detected alterations in the intrinsic pathway might be an independent predictor for 30-day mortality in patients with bleeding and could be useful for decision making regarding treatment with fresh frozen plasma.