Key result
Rotational thromboelastometry demonstrated normal fibrinolysis with a 100% EXTEM lysis index at 30 minutes, allowing for the safe placement of regional anesthesia after intrapleural rtPA administration.
Why the study?
Does ROTEM provide valuable reassurance on coagulation status in patients who have received intrapleural rtPA before regional anesthesia?
Case Report (n=1)
No
Does ROTEM provide valuable reassurance on coagulation status in patients who have received intrapleural rtPA before regional anesthesia?
ROTEM can be used to assess coagulation status and ensure the safety of regional anesthesia in patients who have recently received intrapleural rtPA.
ROTEM may reassure coagulation status for regional anesthesia after intrapleural rtPA in isolated cases; leaves open need for prospective validation before broader use.
We report a case of a 45-year-old male who underwent thoracotomy for empyema and received multiple doses of intrapleural recombinant tissue plasminogen activator (rtPA). Given the recent administration of rtPA, the acute pain service performed a rotational thromboelastometry (ROTEM) test to assess coagulation before proceeding with regional anesthesia. The ROTEM results indicated normal to hypercoagulable clotting parameters, with a normal extrinsic thromboelastometry (EXTEM) lysis index at 30 minutes, suggesting no systemic effects of rtPA. Based on these findings, a single-shot paravertebral block was successfully performed, and subsequent pain management included a thoracic epidural without complication or evidence of spinal hematoma. This case demonstrates that ROTEM can provide valuable reassurance on coagulation status in patients who have received intrapleural rtPA, helping to assess the safety of regional anesthesia.
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DeLeon et al. (2024) conducted a case report in Empyema and post-thoracotomy pain (n=1). Rotational thromboelastometry (ROTEM) was evaluated on Coagulation status assessed by EXTEM lysis index at 30 minutes. Rotational thromboelastometry demonstrated normal fibrinolysis with a 100% EXTEM lysis index at 30 minutes, allowing for the safe placement of regional anesthesia after intrapleural rtPA administration.
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