Redefining haemostasis: Role of rotational thromboelastometry in critical care settings

doi:10.5492/wjccm.v14.i2.102521

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World Journal of Critical Care Medicine

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World J Crit Care Med. Jun 9, 2025; 14(2): 102521
Published online Jun 9, 2025. doi: 10.5492/wjccm.v14.i2.102521

Table 4 Monitoring anticoagulant effects using rotational thromboelastometry

Anticoagulant type	ROTEM parameters	Details
Parenteral anticoagulants
UFH	INTEM-CT	Prolonged CT correlates to aPTT levels
	HEPTEM-CT	Normalized if prolonged CT was due to UFH/LMWH
	INTEM/HEPTEM CT-ratio	Correlation with anti-FXa activity > 0.1 IU/mL
LMWH	INTEM-CT	Low sensitivity, but prolonged only if anti-FXa activity is > 0.4 IU/mL
	NATEM/NAHEPTEM CT-ratio	Correlates with anti-FXa activity > 0.1 IU/mL
	TFTEM	Correlates anti-FXa activity
	PiCT	Correlates anti-FXa activity
Fondaparinux	INTEM-CT	Only prolonged in case of supratherapeutic plasma concentrations
Direct thrombin inhibitors	EXTEM-CT	Correlation with plasma concentrations of argatroban and bivalirudin
Direct thrombin inhibitors	ECATEM-CT	Prolongation specific for direct thrombin inhibitors
Oral anticoagulants
VKAs	EXTEM-CT	Correlates with PT-INR
	INTEM and HEPTEM-CT	INTEM and HEPTEM CT values typically remain normal
Dabigatran (correlates with plasma concentration)	ECATEM-CT	Prolonged, specific for direct thrombin inhibitors
	TFTEM/ECATEM CT-ratio < 2	Detects dabigatran effects
	EXTEM and FIBTEM-CT	Prolongation of CT in EXTEM and FIBTEM due to dabigatran
	INTEM and HEPTEM-CT	Prolonged clotting times
Rivaroxaban, edoxaban (correlates with plasma concentration)	TFTEM and EXTEM-CT	Prolongation of CT with rivaroxaban and edoxaban
	TFTEM/ECATEM CT-ratio > 2	Detects rivaroxaban and edoxaban
	INTEM and HEPTEM-CT	Less sensitive to rivaroxaban/edoxaban
	ECATEM-CT	Normal, specific for DTIs
Apixaban (correlates with plasma concentration)	EXTEM and INTEM-CT	Less sensitive to low concentrations of apixaban
	TFTEM/ECATEM CT-ratio > 2	Detects apixaban effects
	TFTEM CT	Sensitive to low concentrations of apixaban
	ECATEM-CT	Normal, specific for DTIs

CT: Clotting time; ROTEM: Rotational thromboelastometry; NATEM: Nonactivated thromboelastometry; TFTEM: Low tissue factor thromboelastometry; PiCT: Prothrombinase-induced clotting time; LMWH: Low-molecular-weight heparin; UFH: Unfractionated heparin; VKAs: Antivitamin K antagonists; ECATEM: Ecarin-activated assay; aPTT: Activated partial thromboplastin time; anti-FXa: Anti-factor X activated; INR: International normalized ratio; PT: Prothrombin time; DTI: Direct thrombin inhibitor.

Citation: Kataria S, Juneja D, Singh O. Redefining haemostasis: Role of rotational thromboelastometry in critical care settings. World J Crit Care Med 2025; 14(2): 102521
URL: https://www.wjgnet.com/2220-3141/full/v14/i2/102521.htm
DOI: https://dx.doi.org/10.5492/wjccm.v14.i2.102521