The Clinical Utilisation of Rotational Thromboelastometry (ROTEM)

Jesse Hanson

Rotational Thromboelastometry (ROTEM) is a viscoelastic coagulation testing modality that provides a global assessment of coagulation. There is limited information in the veterinary literature regarding the clinical use of ROTEM in dogs. To explore this, a historical case series was performed which describes the common reasons for ROTEM testing within a cohort of dogs at a university veterinary hospital and describes coagulation-related treatments in these dogs. Cases were randomly selected from the ROTEM database at The Animal Hospital at Murdoch University and all ROTEM test parameters were recorded. Electronic medical records were reviewed and patient signalment, reason for testing, risk factors for haemorrhage and thrombosis, and coagulation-related treatments were recorded. Additional information recorded included the number of ROTEMs performed as well as the types of ROTEM performed. This information was uploaded to an online database (REDCap). Descriptive statistics were reported. One hundred and seventy-nine cases were included for analysis. Mean (min-max) age was 7.8 years (0.2-16 years). A variety of breeds were represented, with mixed breed dogs (n=30) and greyhounds (n=16) the most frequently represented. Reason for ROTEM included suspected or confirmed active haemorrhage (n=45), risk of haemorrhage (n=78), suspected or confirmed thrombosis (n=19), or risk of thrombosis (n=55). More than one reason could be selected for each subject. Multiple risk factors for haemorrhage were reported including congenital and acquired coagulopathies and surgical procedures. Common risk factors for thrombosis included sepsis (n=15) and neoplasia (n=13). Seventy-eight dogs received treatment for hypocoagulability including transfusion of packed red blood cells (n=45), plasma products (n=28), or fresh whole blood (n=6). Other treatments for hypocoagulability included tranexamic acid (n=37) and surgical haemostasis (n=21). Thirty-eight dogs were treated for hypercoagulability with treatments including clopidogrel (n=20), rivaroxaban (n=17), and low molecular weight heparins (n=12). One hundred and twenty-nine dogs survived to discharge. Our study found that both risk of haemorrhage and thrombosis were assessed using ROTEM. Hypercoagulable disease states were the most frequently recognised. Despite this, treatment for hypocoagulability was more common than treatment for hypercoagulability.

The Clinical Utilisation of Rotational Thromboelastometry (ROTEM)

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