# Distinctive Features of Rotational Thromboelastometry in Patients with Infective Endocarditis Undergoing on-Pump Cardiac Surgery: A Retrospective Propensity Score-matched Observational Study

## TL;DR

This study compares coagulation profiles in infective endocarditis patients versus controls during heart surgery using rotational thromboelastometry.

## Contribution

Identifies distinct viscoelastic clotting patterns in endocarditis patients requiring more PCC during surgery.

## Key findings

- Endocarditis patients had prolonged EXTEM clotting times compared to controls.
- Endocarditis patients showed higher FIBTEM-A5 clot firmness and required more PCC.
- Transfusions of platelets, FFP, and FC did not differ significantly between groups.

## Abstract

The haemostatic system plays a role in development of valvular vegetations and systemic activation of coagulation, contributing to both thrombosis and consumption coagulopathy. Patients with infective endocarditis undergoing valvular surgery pose unique challenges to the surgical team. Rotational thromboelastometry (ROTEM), a point-of-care viscoelastic clotting test, can help assess coagulation and guide therapy. This retrospective propensity score-matched study explores ROTEM's distinctive features in endocarditis patients compared to others undergoing cardiac surgery.

A retrospective analysis was performed on patients undergoing valvular surgery between May 31, 2022, and August 31, 2024. ROTEM assessments were conducted during extracorporeal circulation and post-heparin reversal. The study group consisted of patients with endocarditis, while propensity score matching created a control group of patients without endocarditis. The primary outcome was on-pump ROTEM results; secondary outcomes included utilisation of red blood cells (pRBC), fibrinogen concentrate (FC), prothrombin complex concentrate (PCC), fresh frozen plasma (FFP), and platelets.

In both groups (23 patients each), endocarditis patients had prolonged EXTEM clotting times (136 vs 96 s, P = .001) and higher FIBTEM-A5 clot firmness (19 vs 13 mm, P = .012). They required more PCC (3000 vs 2500 units, P = .014), while transfusions of platelets (P = .281), FFP (P = 1.000), and FC (P = .109) did not differ significantly.

Endocarditis patients demonstrate distinct viscoelastic profiles with prolonged clotting times and increased clot firmness, necessitating greater PCC supplementation. Further research is warranted to optimise ROTEM target values to balance bleeding and thrombotic risks.