A Prospective Analysis of Viscoelastic Assays, Platelet Aggregometry, and Standard Laboratory Tests in Predicting Perioperative Blood Loss in Cardiac Surgery
Orazymbetov Y. Aitaliyev S. Jakuška P. Veikutienė A. Lenkutis T. Zhumagaliyev R. Skipskis V. Aitaliyev Y. Saudargienė A. Benetis R.
January-December 2026SAGE Publications Inc.
Clinical and Applied Thrombosis/Hemostasis
2026#32
Background: Postoperative bleeding following cardiopulmonary bypass (CPB) remains a significant challenge. Although viscoelastic testing is increasingly used, the relative contributions of fibrinogen, platelet count and clot firmness to blood loss remain debated. We evaluated the diagnostic accuracy of thromboelastometry (ROTEM) compared with platelet aggregometry (PA) and standard tests, using the Hb/kg index to quantify blood loss. Methods: In this prospective observational study conducted at the University Hospital (Kaunas, Lithuania) we enrolled 79 patients undergoing elective cardiac surgery. Simultaneous assessments using ROTEM (EXTEM, INTEM, FIBTEM, PLTEM), PA, and standard coagulation tests were performed. The primary endpoint was the correlation between haemostatic parameters and the Hb/kg Index. Diagnostic accuracy for hypofibrinogenaemia (<2.5 g/L) and thrombocytopenia (<150 × 109/L) was assessed using Receiver Operating Characteristic (ROC) analysis. Results: Post-CPB platelet count and fibrinogen decreased significantly (p < 0.001). However, a notable dissociation was found: neither platelet count, PLTEM, PA parameters nor standard clotting times correlated with the Hb/kg Index (p > 0.05). In contrast, viscoelastic measures of clot firmness (FIBTEM A10) and fibrinogen levels significantly predicted blood loss. FIBTEM A10 (12 mm) demonstrated excellent accuracy for hypofibrinogenaemia (AUC = 0.888), providing a sensitivity of 96% and a negative predictive value of 97.4%. Conclusion: Post-CPB bleeding is primarily driven by reduced clot firmness and fibrinogen deficiency rather than by platelet count or aggregation defects. FIBTEM A10 is a superior rapid detector of hypofibrinogenaemia. Transfusion algorithms should prioritize the maintenance of functional clot firmness over the correction of static platelet numbers.
cardiac surgery , fibrinogen , Hb/kg index , platelet aggregation , thromboelastometry
Text of the article Перейти на текст статьи
Department of Cardiac, Thoracic and Vascular Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Lithuanian University of Health Sciences, Kaunas, Lithuania
Department of Cardiac Surgery, National Scientific Medical Centre, Astana, Kazakhstan
Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Department of Anaesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
West Kazakhstan Medical University, Aktobe, 030019, Kazakhstan
Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
Department of Cardiac
Department of Cardiac Surgery
Institute of Cardiology
Department of Anaesthesiology
West Kazakhstan Medical University
Neuroscience Institute
10 лет помогаем публиковать статьи Международный издатель
Книга Публикация научной статьи Волощук 2026 Book Publication of a scientific article 2026