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Evaluation of the new device ROTEM® platelet
T.Lang1), M. Tollnick2), M. Rieke1)
1)Gerinnungsambulanz Südheide, 2)MedLab
A
Südheide, GERMANY
Introduction
B
In perioperative blood management Thrombelastometry/-graphy is an estabished
diagnostic tool in goal directed therapy of coagulopathy leading to significant
reduction of blood transfusion. However this device is not able to dectect impairment
in „primary haemostasis“ such as reduced platelet reactivity by Aspirin ingestion.
The development of ROTEM® platelet allows the additional measurement of platelet
aggregation in a single device and so saving time and space in the operation theatre.
Fig. 1A: Multiplate ®
Fig. 1B: ROTEM®platelet
Aim of the Study:
Comparison of two different devices in platelet impedance aggregometry: Multiplate® versus the new device
ROTEM® platelet.
Material and Methods:
73 samples were compared between Multiplate® and ROTEM® platelet. Samples were obtained from healthy volunteers without
ingestion of Aspirin/Clopidogrel (57 samples) and from patients with 100mg/d Aspirin (16 samples). Both systems are based on
platelet impedance aggregometry: the adhesion and aggregation of platelets on the sensor surface enhances the eletrical resistance
(impedance) between two electrodes (Fig. 2). Platelets may be stimulated with various agonists such as aracidonic acid or Thrombin
Receptor Activating Peptide (TRAP) so different pathways of platetes are investigated.
The result is given in Ohm (ROTEM® platelet) or in arbitrary aggregation unit (AU, Multiplate®) and plotted against time. Platelet
aggregation is quantified by calculation of area under the cuve (AUC in Ω*min).
Citrated whole blood was stimulated in Multiplate® with specific Multiplate®-reagents: TRAPtest® and ASPItest®. In ROTEM®
platelet samples were stimulated with specific ROTEM®-reagents: trap-tem®, ara-tem® and with the Multiplate®-reagent ASPItest®.
Fig. 2: Principle of ROTEM®platelet
Results:
A
Typical reacion curves of ROTEM® platelet without A: Samples WITHOUT Aspirin Ingestion (n=57)
B: Samples WITH Aspirin Ingestion (n=16)
and with Asprin ingestion are given in Figure 3.
ROTEM platelet
MULTIPLATE
ROTEM platelet
MULTIPLATE
There was moderate correlation between both
methods in TRAP (r=0,67) but AUC of ROTEM® MW
108,2
80,2
90,6
70,8
52,1
MW
103,8
11,6
50,9
63,8
14,3
platelet were in medium 50% higher compared to Median 103
78
88
70
51
Median
96
8
48
65
11
®
Multiplate (Tab. 1). Using Arachidonic acid Stdv
21,7
23,6
21,1
11,5
13,9
Stdv
26,3
10,1
25
16,7
10
(r=0,89) for platelet stimulation there was a good min
50
4
13
42
8
min
62
0
16
28
0
correlation between both devices. AUC of ROTEM® max
162
141
140
104
93
max
152
38
104
101
40
platelet were in medium 50% higher compared to
Multiplate® as noticed in stimulation with TRAP Tab. 1: Results are given in AUC ; Multiplate -reagent
(Tab 1). Interestingly using the Multiplate®-reagent
ASPItest® in ROTEM® platelet AUC were about 12% higher compared to ROTEM®-reagent ara-tem® in samples
without aspirin ingestion (Tab 1a). However using the Multiplate®-reagent ASPItest® in ROTEM® platelet in samples
with Aspirin ingestion reaction curve showed moderate elevation compared to no reaction to device specific reagents
(Tab. 1b).
®
trap-tem®
B
ara-tem®
®
ASPItest® 1)
TRAPtest® 1)
1)
Fig. 3: Reaction curve of sample without (A)
and with (B) Aspirin in ROTEM®
platelet
®
ASPItest® 1)
trap-tem®
ara-tem®
®
ASPItest® 1)
TRAPtest® 1)
ASPItest® 1)
®
160
Using AUC=30 as cut-off for Aspirin-effect all Aspirin-samples are discriminated in both
systems. In both systems 2 Aspirin-samples showed an AUC>30 suggesting ASS-nonresponder. Two samples with no Aspirin ingestions showed an AUC<30 in both systems
suggesting an Aspirin effect.
There was no correlation of time delay between sample collection and measuremet and the
AUC (time range: 10min-6h) independent of the activator.
ara-tem® (ROTEM® platelet)
140
120
100
80
60
ASS positiv (n=10)
40
ASS negativ (n=44)
20
0
0
20
40
60
80
100
120
140
160
ASPItest® (Multiplate®)
Fig. 4: Correlation of AUC (Ω*min) beween ROTEM® platelet and Multiplate® using
Arachidonic acid for stimulation
Conclusion: There is no difference between ROTEM® platelet and Multiplate® in
detection/exclusion of Aspirin effect in citrated whole blood.
Discussion:
The discrimination between normal and Aspirin-samples was identical between Multiplate® and ROTEM ® platelet using AUC=30 as
cut-off and Arachidonic acid for stimulation. Also Aspirin resistance is reliable detected by both devices.
The higher AUC in ROTEM ® platelet may be also caused by different activators and electrodes. However using Multiplate-reagent
ASPItest® in ROTEM® platelet will lead to false positive reaction curves in samples with Aspirin ingestion and should be avoided.
ROTEM ® platelet allows a more easily performance of both measurements Thrombelastometry and platelet aggregation using a single
device resulting in saving of time and space.
GTH 2014, Vienna

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