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. 2021 Aug;48(4):203-209.
doi: 10.1159/000513922. Epub 2021 Jan 14.

Coagulation under Mild Hypothermia Assessed by Thromboelastometry

Tobias Nitschke  1 , Philipp Groene  1 , Alice-Christin Acevedo  1 , Tobias Kammerer  1   2 , Simon T Schäfer  1
Affiliations

Coagulation under Mild Hypothermia Assessed by Thromboelastometry

Tobias Nitschke et al. Transfus Med Hemother. 2021 Aug.

Abstract

Introduction: While previous studies have shown a significant impact of extreme hypo- and hyperthermia on coagulation, effects of much more frequently occurring perioperative mild hypothermia are largely unknown. This study therefore aimed to analyze the effects of mild hypothermia using rotational thromboelastometry in vitro.

Materials and methods: Twelve healthy volunteers were included in this study. Standard thromboelastometric tests (EXTEM, INTEM, FIBTEM) were used to evaluate coagulation in vitro at 39, 37, 35.5, 35, and 33°C. Beyond standard thromboelastometric tests, we also evaluated the effects of mild hypothermia on the TPA-test (ClotPro, Enicor GmbH, Munich, Germany), a new test which aims to detect fibrinolytic capacity by adding tissue plasminogen activator to the sample. Data are presented as the median with 25/75th percentiles.

Results: Extrinsically activated coagulation (measured by EXTEM) showed a significant increase in clot formation time (CFT; 37°C: 90 s [81/105] vs. 35°C: 109 s [99/126]; p = 0.0002), while maximum clot firmness (MCF) was not significantly reduced. Intrinsically activated coagulation (measured by INTEM) also showed a significant increase in CFT (37°C: 80 s [72/88] vs. 35°C: 94 s [86/109]; p = 0.0002) without significant effects on MCF. Mild hypothermia significantly increased both the lysis onset time (136 s [132/151; 37°C] vs. 162 s [141/228; 35°C], p = 0.0223) and lysis time (208 s [184/297; 37°C] vs. 249 s [215/358; 35°C]; p = 0.0259).

Conclusion: This demonstrates that even under mild hypothermia coagulation is significantly altered in vitro. Perioperative temperature monitoring and management are greatly important and can help to prevent mild hypothermia and its adverse effects. Further investigation and in vivo testing of coagulation under mild hypothermia is needed.

Keywords: Coagulation; Hypothermia; Rotational thromboelastometry; Thromboelastography; Thromboelastometry.

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Conflict of interest statement

The authors declare no conflict of interests.

Figures

Fig. 1
Fig. 1
Thromboelastometric tests performed at 33, 37, and 39°C. Graphs show the median and interquartile range. A CFT (EXTEM). B CFT (INTEM). C TT20 (EXTEM). D TT20 (INTEM). E MCF (FIBTEM). F LT (TPA-test).
Fig. 2
Fig. 2
Thromboelastometric tests performed under mild hypothermia (35, 35.5, 36°C) and at 37°C. Graphs show the median and interquartile range. A CFT (EXTEM). B CFT (INTEM). C TT20 (EXTEM). D TT20 (INTEM).E MCF (FIBTEM). F LT (TPA-test).
See this image and copyright information in PMC

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