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ROTEM analyses of low molecular weight heparin effects with vitro induced thrombocythopenia

Kander, Thomas LU orcid and Schött, Ulf LU (2021) In Women Health Care and Issues 4(1). p.1-9
Abstract
Background: Thrombocytopenia is correlated to hemorrhagic complications in patients with low molecular weight heparin (LMWH) thromboprophylaxis.

Aims: The aims of our study were to investigate an experimentally induced in vitro thrombocytopenia and then adding 2 types of LMWHs in vitro. Our hypothesis was that a platelet depleted whole blood sample could reflect a stronger synergistic anticoagulative effect of in vitro added LMWH than in the non-manipulated blood.
Method: Two venous citrated blood samples were consecutively drawn from 8 patient’s gynaecologic cancer and normal routine coagulation laboratory analyses immediately preopewratively. One of the two samples had... (More)
Background: Thrombocytopenia is correlated to hemorrhagic complications in patients with low molecular weight heparin (LMWH) thromboprophylaxis.

Aims: The aims of our study were to investigate an experimentally induced in vitro thrombocytopenia and then adding 2 types of LMWHs in vitro. Our hypothesis was that a platelet depleted whole blood sample could reflect a stronger synergistic anticoagulative effect of in vitro added LMWH than in the non-manipulated blood.
Method: Two venous citrated blood samples were consecutively drawn from 8 patient’s gynaecologic cancer and normal routine coagulation laboratory analyses immediately preopewratively. One of the two samples had its buffy coat pipetted away into a separate tube. Half of the buffy coat was returned to the same sample (treated sample). 3x500 μl of blood from the non-treated sample was added to 3 separate microtubes and corresponding for the treated sample. Thromboprophylactic doses corresponding to an in vivo peak effect 0.5 anti-Xa international units/ml of tinzaparin and enoxaparin were added both to untreated and treated samples – 2 microtubes were unheparinized (treated/untreatedsample).

All samples were analysed with rotational thromboelastometry (ROTEM).

Results: Wilcoxon matched-pairs signed rank tests of the in-group differences between non-non-treated and treated samples showed no significant differences (p≤0.05) for any of the parameters analysed with the ROTEM-INTEM reagent regardless of heparinization or not. Calculation of non-parametric spearman correlation for clotting time (CT) vs. platelet count (PLC) were not significant for any group. Tinzaparin was clearly observed to prolong CT in the buffy-coat lowered blood from two patients.

Conclusions: Our results corroborate previous research that ROTEM cannot detect anticoagulative effects of low dose LMWH in patients with normal PLC. In two patients there was a clear prolongation of clot initiation after tinzaparin that warrants further studies on a more developed in vitro induced thrombocytopenia model.


Keywords: thrombocytopenia; thromboprohylaxis; cancer; thromboelastography; low molecular weight heparin (Less)
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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Women Health Care and Issues
volume
4
issue
1
pages
1 - 9
publisher
Auctores Publishing LLC
ISSN
2642-9756
language
English
LU publication?
yes
id
2b00f35a-8010-445c-b080-bf907f658b49
alternative location
https://www.auctoresonline.org/journals/women-health-care-and-issues/article-in-press/1338
date added to LUP
2021-03-08 19:36:57
date last changed
2021-03-10 02:34:34
@article{2b00f35a-8010-445c-b080-bf907f658b49,
  abstract     = {{Background: Thrombocytopenia is correlated to hemorrhagic complications in patients with low molecular weight heparin (LMWH) thromboprophylaxis.                                                 <br/><br/>Aims: The aims of our study were to investigate an experimentally induced in vitro thrombocytopenia and then adding 2 types of LMWHs in vitro.  Our hypothesis was that a platelet depleted whole blood sample could reflect a stronger synergistic anticoagulative effect of in vitro added LMWH than in the non-manipulated blood.       <br/>Method: Two venous citrated blood samples were consecutively drawn from 8 patient’s gynaecologic cancer and normal routine coagulation laboratory analyses immediately preopewratively. One of the two samples had its buffy coat pipetted away into a separate tube. Half of the buffy coat was returned to the same sample (treated sample). 3x500 μl of blood from the non-treated sample was added to 3 separate microtubes and corresponding for the treated sample. Thromboprophylactic doses corresponding to an in vivo peak effect 0.5 anti-Xa international units/ml of tinzaparin and enoxaparin were added both to untreated and treated samples – 2 microtubes were unheparinized (treated/untreatedsample).<br/><br/>All samples were analysed with rotational thromboelastometry (ROTEM).                                                                          <br/><br/>Results: Wilcoxon matched-pairs signed rank tests of the in-group differences between non-non-treated and treated samples showed no significant differences (p≤0.05) for any of the parameters analysed with the ROTEM-INTEM reagent regardless of heparinization or not. Calculation of non-parametric spearman correlation for clotting time (CT) vs. platelet count (PLC) were not significant for any group. Tinzaparin was clearly observed to prolong CT in the buffy-coat lowered blood from two patients.                                                               <br/><br/>Conclusions: Our results corroborate previous research that ROTEM cannot detect anticoagulative effects of low dose LMWH in patients with normal PLC. In two patients there was a clear prolongation of clot initiation after tinzaparin that warrants further studies on a more developed in vitro induced thrombocytopenia model.<br/><br/><br/>Keywords: thrombocytopenia; thromboprohylaxis; cancer; thromboelastography; low molecular weight heparin}},
  author       = {{Kander, Thomas and Schött, Ulf}},
  issn         = {{2642-9756}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{1}},
  pages        = {{1--9}},
  publisher    = {{Auctores Publishing LLC}},
  series       = {{Women Health Care and Issues}},
  title        = {{ROTEM analyses of low molecular weight heparin effects with vitro induced thrombocythopenia}},
  url          = {{https://www.auctoresonline.org/journals/women-health-care-and-issues/article-in-press/1338}},
  volume       = {{4}},
  year         = {{2021}},
}