Cardiothoracic & vascular anesthesia
The Diagnostic Accuracy of EXTEM and HEPTEM Clotting Times Versus Standard Laboratory Tests in Cardiac Surgical Patients With and Without Normal FIBTEM Values
Authors' conclusion
EXTEM CT >80 seconds and HEPTEM CT >280 seconds have high sensitivities and NPVs for INR >2.0, which would effectively "rule out" INR >2.0 as a cause for excessive bleeding. However, the low specificities and PPVs indicate they would be less effective in ruling it in. INTEM CT >205 seconds had low PPV and NPV in identifying aPTT >38.5 seconds.
Study context
- Population
- Cardiac surgical patients, measured post-heparin reversal after CPB
- Participants
- 176 patients
- Comparison
- EXTEM, INTEM and HEPTEM clotting times (CTs) vs laboratory international normalized ratio (INR) and activated partial thromboplastin time (aPTT) as reference standards
- Outcome
- Sensitivity, specificity, PPV and NPV of ROTEM CTs for INR ≥2.0 and aPTT ≥38.5 seconds
- Follow-up
- Post-heparin reversal after CPB
Methodological detailsretrospective, tertiary referral hospital
- Retrospective
- Tertiary referral hospital
Performance
As reported in the abstract
Diagnostic accuracy (all patients)
| Strategy | Sensitivity | Specificity | PPV | NPV |
|---|---|---|---|---|
| EXTEM CT >80 seconds | 1.00 | 0.25 | 0.17 | 1.00 |
| HEPTEM CT >280 seconds | 0.91 | 0.38 | 0.18 | 0.97 |
| INTEM CT >205 seconds | 0.97 | 0.11 | 0.57 | 0.75 |
Sensitivity
EXTEM CT >80 seconds1.00
HEPTEM CT >280 seconds0.91
INTEM CT >205 seconds0.97
Specificity
EXTEM CT >80 seconds0.25
HEPTEM CT >280 seconds0.38
INTEM CT >205 seconds0.11
PPV
EXTEM CT >80 seconds0.17
HEPTEM CT >280 seconds0.18
INTEM CT >205 seconds0.57
NPV
EXTEM CT >80 seconds1.00
HEPTEM CT >280 seconds0.97
INTEM CT >205 seconds0.75
- Prevalence of INR ≥2.0
- 13%
Further findings
Diagnostic accuracy, subset with normal FIBTEM A5 (>6 mm) (subgroup)
- Values similar to all patients
Original publication
The Diagnostic Accuracy of EXTEM and HEPTEM Clotting Times Versus Standard Laboratory Tests in Cardiac Surgical Patients With and Without Normal FIBTEM Values. J Cardiothorac Vasc Anesth. Published 27 June 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →