Limitations of ROTEM in Platelet Function Assessment
Introduction to ROTEM Limitations
- Standard ROTEM is not recommended for testing platelet function because it bypasses primary hemostasis and is insensitive to antiplatelet agents and platelet dysfunction, as stated by the International Society on Thrombosis and Haemostasis 1, 2, 3
- ROTEM uses reagents that activate coagulation, bypassing primary hemostasis entirely, making it insensitive to antiplatelet agents or any kind of platelet inhibition, according to the International Society on Thrombosis and Haemostasis 1, 2, 3
- ROTEM cannot detect disorders of primary hemostasis because it does not assess the contribution of endothelium to coagulation, as noted by the International Society on Thrombosis and Haemostasis 1, 2, 3
Alternative Assessment Methods
- The American Society of Anesthesiologists recommends obtaining platelet count alongside viscoelastic assays when coagulopathy is suspected, with a strength of evidence rated as high 4, 5, 6
- The European trauma guidelines recommend avoiding routine use of POC platelet function devices due to mixed results and limited value when platelet counts are low, with a strength of evidence rated as moderate 7
Important Considerations
- Previous studies suggesting the safety of neuraxial anesthesia in pregnant women with platelet counts as low as 56,000/mm³ based on normal TEG profiles need to be interpreted with extreme caution, as TEG/ROTEM are not adequate measures of platelet function, as warned by the International Society on Thrombosis and Haemostasis 1, 2
- Calculating platelet contribution by subtracting FIBTEM maximum clot elasticity from EXTEM has been suggested, but this metric has not been validated in clinical practice, according to the International Society on Thrombosis and Haemostasis 1, 2, 3