Hemoglobin Concentration Impacts Viscoelastic Hemostatic Assays in ICU Admitted Patients*

David Roh; Tiffany Chang; Aditya Kumar; Devin Burke; Glenda Torres; Katherine Xu; Winni Yang; Azzurra Cottarelli; Ernest E. Moore; Angela Sauaia; Kirk C. Hansen; Ángela Velázquez; Amelia K. Boehme; Athina Vrosgou; Shivani Ghoshal; Soojin Park; Sachin Agarwal; Jan Claassen; E. Sander Connolly; Gebhard Wagener; Richard O. Francis; Eldad A. Hod

doi:10.1097/ccm.0000000000005700

Key Points

To evaluate whether hemoglobin concentration significantly alters viscoelastic functional coagulation parameters in critically ill patients admitted to the ICU.
Conducted a multicenter observational cohort study across tertiary ICUs evaluating rotational thromboelastometry (ROTEM, n = 34) and thromboelastography (TEG, n = 239) in acute intracerebral hemorrhage patients, alongside a surgical ICU cohort using ROTEM (n = 121).
Performed a separate in vitro laboratory experiment using serial hemoglobin modifications of intracerebral hemorrhage patient blood samples to measure direct effects on ROTEM tracings.
Hemoglobin concentration correlated directly with coagulation kinetics (ROTEM r = 0.46, p = 0.01; TEG r = 0.49, p < 0.0001) and inversely with clot strength (ROTEM r = -0.52, p = 0.002; TEG r = -0.40, p < 0.0001) in intracerebral hemorrhage cohorts.
Identified similar significant linear regression relationships in the perioperative ICU cohort (n = 121).
Demonstrated in vitro that experimentally diluting hemoglobin concentrations progressively accelerated coagulation kinetics and increased clot strength measurements on ROTEM.

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Implication

Observational cohort study shows lower hemoglobin spuriously accelerates coagulation kinetics and increases clot strength in ICU patients, indicating viscoelastic assays may mask hypocoagulability.

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Cite This Study

Roh et al. (2023) studied this question.

synapsesocial.com/papers/6a9f796e1e2946a2fd9657c2 https://doi.org/10.1097/ccm.0000000000005700

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Hemoglobin Concentration Impacts Viscoelastic Hemostatic Assays in ICU Admitted Patients*

Key Points

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Implication

Discussion

Cite This Study

Hemoglobin Concentration Impacts Viscoelastic Hemostatic Assays in ICU Admitted Patients*

Key Points

No abstract yet

Implication

Discussion

Cite This Study

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