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Annals of Cardiac Anaesthesia logoLink to Annals of Cardiac Anaesthesia
. 2016 Oct-Dec;19(4):584–586. doi: 10.4103/0971-9784.191559

PLATELET AGGREGOMETRY INTERPRETATION USING ROTEM – PART – II

Vandana Bhardwaj 1, Poonam Malhotra Kapoor 1,
PMCID: PMC5070314  PMID: 27716685

The ROTEM platelet system is a new module that can be added to the ROTEM, enabling simultaneous analysis of thromboelastometry measurements and platelet aggregation using impedance aggregometry.

Video 1.

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Platelet aggregometry using ROTEM

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Color coded graph for interpretation

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Reference values of INTEM, HEPTEM, EXTEM, and FIBTEM

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ROTEM TEMOGRAM with decreased Fibrinogen

ROTEM platelet aggregation graph

In ROTEM PM, effect of various antiplatelet drugs can be studied through single use agent; ARA-TEM for cyclooxygenase inhibitors, ADP-TEM for ADP receptor blocker and TRAP-TEM for glycoprotein IIbIIIa receptor blockers.

ROTEM platelet mapping system

ROTEM PM system3 is a new module that can be added to ROTEM, enabling simultaneous analysis of thromboelastometry & platelet aggregation using impedance aggregometry (Figure Below).

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ROTEM monitor showing simultaneous graphs of thromboelastometry (upper 4) and platelet aggregometry (lower 2)

RAPID ASSESSMENT IN ONLY 10 MINUTES

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IMPEDANCE AGGREGOMETRY: ACTIVATOR PATHWAYS

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Impedance aggregometry: Activator pathways

ROTEM PLATELET ACTIVATORS AND PARAMETERS

Platelet aggregometry tests

  • 1.

    Aratem – Arachidonic acid

  • 2.

    Traptem – Thrombin activating Peptide

  • 3.

    Adptem – Adenosine Diphosphate

Platelet Parameters

  • 1.

    Amplitude at 6 Min.-A6 – It describes how well the platelets aggregate after selective activation.

  • 2.

    Maximum Slope. MS – It describes how quick the platelets aggregate after selective activation.

  • 3.

    Area Under the Curve-AUC- It reflects the overall platelet aggregation.

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Graph showing different therapies

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Graph showing increased and decreased clotting time

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Administration of fibrinogen concentrate

Conclusion:

Major bleeding is a partially modifiable risk factor, and adequate preemptive and treatment strategies should be applied to limit this event. ROTEM PLATELET AGGREGOMETRY provides great blood product usage and is cost effective when used in time.

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Articles from Annals of Cardiac Anaesthesia are provided here courtesy of Wolters Kluwer -- Medknow Publications

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