Mortality and Thromboembolic Events in Hypercoagulable States From ROTEM-Thromboelastometry in Patients Who Undergo Coronary Bypass Surgery

Abstract

Objective: To test the hypothesis that post CABG thromboembolic events and MACCE at 1, 3, 6,and 12 months after surgery are related to the pre-surgical TEG status and investigate the prevalence of preoperative hypercoagulability in the high risk population in Thailand assessed by Rotational Thromboelastography (ROTEM). Method: This is a prospective cohort study consecutively assessing pump CABG surgery patients. Hypercoagulability was defined as any clotting time (CT) clot formation time (CFT), amplitude 10 min after CT (A10), or maximum clot firmness (MCF) in ROTEM measurement above the upper normal limit of EXTEM, INTEM and FIBTEM in the worldwide population. Results: Forty per cent of patients show a state of hypercoagulability in terms of ROTEM. The majority of hypercoagulable patients were female. ROTEM data illustrate the significant upward trends of A10, A20 and MCF above the upper limit in hypercoagulable patients with levels of 90%, 68% and 95% in EXTEM, INTEM AND FIBTEM, respectively. The mortality and MACCE event rates were slightly increased in hypercoagulable patients both at 30 days and at 1 year with statistical significance in all event rates at the 1-year follow-up. In univariate terms, ROTEM hypercoagulability is also associated with uneventful combinations in the follow-up at 1 year. Conclusion: Hypercoagulability was found in 43% of on pump CABG patients and is associated with high risk for mortality and morbidity in the 1-year follow-up.