Purpose During bleeding, the decrease A10EXTEM and A10FIBTEM (the clot firmness at 10 min) measured by rotational thromboelastometry (Rotem) can detect alterations in the fibrin contribution to clot firmness (FIBTEM) and in the extrinsic pathway (EXTEM). However, the significance of a decrease of A10FIBTEM and A10EXTEM for risk stratification in patients with bleeding remains unclear. Methods 1942 consecutive patients were retrospectively examined between 2014 and 2020. All patients were tested with Rotem during a hemorrhage at Saarland University Hospital. A10EXTEM and A10FIBTEM and their association with mortality at 30 days were tested using C statistic. A threshold value for A10EXTEM reaching a specificity > 90% for 30-day mortality was selected and for A10FIBTEM was fixed at <6 mm. Adjusted hazard ratios (adjHR [95% confidence interval]) were calculated with multivariable Cox models. Results A10EXTEM (C statistic 0.57, selected threshold≤39 mm) had a predictive power for 30-day mortality, whereas A10FIBTEM did not. The 30-day mortality rate was significantly increased in patients with A10EXTEM≤39 mm (A10EXTEM≤39 mm: 32% versus A10EXTEM>39 mm: 16%, p < 0.001) and A10FIBTEM<6 mm (A10FIBTEM<6 mm: 25% versus A10FIBTEM≥6 mm: 18%, p = 0.03). The selected threshold values of A10EXTEM≤39 mm (adjHR 1.7 [1.3–2.3], p < 0.001) and A10FIBTEM<6 mm (adjHR 1.6 [1.1–2.2], p = 0.009) remained independent risk predictors for 30-day mortality even after adjustment for confounding factors. The leading cause of death in these populations were uncontrolled bleeding. Patients with A10FIBTEM<6 mm had significant more fibrinogen administration (A10FIBTEM<6 mm: 2.7 ± 3.7 g versus A10FIBTEM≥6 mm: 0.5 ± 1.6 g, p < 0.001). Conclusion Our results indicate that A10EXTEM-detected alterations in the extrinsic pathway might be independent predictors for 30-day mortality in patients with bleeding. Nevertheless, A10FIBTEM measurements to optimize treatment with fibrinogen is required.

Differences in thromboelastometry parameters A10EXTEM and A10FIBTEM –as independent risk factors for mortality during bleeding

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2026年6月18日

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Hagen Bomberg,
Theresa Mokry,
Neeti Sharma,
Klaus Görlinger,
Stefan Wagenpfeil,
Thomas Volk,
Sven Oliver Schneider

摘要

Purpose

During bleeding, the decrease A10_EXTEM and A10_FIBTEM (the clot firmness at 10 min) measured by rotational thromboelastometry (Rotem) can detect alterations in the fibrin contribution to clot firmness (FIBTEM) and in the extrinsic pathway (EXTEM). However, the significance of a decrease of A10_FIBTEM and A10_EXTEM for risk stratification in patients with bleeding remains unclear.

Methods

1942 consecutive patients were retrospectively examined between 2014 and 2020. All patients were tested with Rotem during a hemorrhage at Saarland University Hospital. A10_EXTEM and A10_FIBTEM and their association with mortality at 30 days were tested using C statistic. A threshold value for A10_EXTEM reaching a specificity > 90% for 30-day mortality was selected and for A10_FIBTEM was fixed at <6 mm. Adjusted hazard ratios (adjHR [95% confidence interval]) were calculated with multivariable Cox models.

Results

A10_EXTEM (C statistic 0.57, selected threshold≤39 mm) had a predictive power for 30-day mortality, whereas A10_FIBTEM did not. The 30-day mortality rate was significantly increased in patients with A10_EXTEM≤39 mm (A10_EXTEM≤39 mm: 32% versus A10_EXTEM>39 mm: 16%, p < 0.001) and A10_FIBTEM<6 mm (A10_FIBTEM<6 mm: 25% versus A10_FIBTEM≥6 mm: 18%, p = 0.03). The selected threshold values of A10_EXTEM≤39 mm (adjHR 1.7 [1.3–2.3], p < 0.001) and A10_FIBTEM<6 mm (adjHR 1.6 [1.1–2.2], p = 0.009) remained independent risk predictors for 30-day mortality even after adjustment for confounding factors. The leading cause of death in these populations were uncontrolled bleeding. Patients with A10_FIBTEM<6 mm had significant more fibrinogen administration (A10_FIBTEM<6 mm: 2.7 ± 3.7 g versus A10_FIBTEM≥6 mm: 0.5 ± 1.6 g, p < 0.001).

Conclusion

Our results indicate that A10_EXTEM-detected alterations in the extrinsic pathway might be independent predictors for 30-day mortality in patients with bleeding. Nevertheless, A10_FIBTEM measurements to optimize treatment with fibrinogen is required.