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Thromboelastometry analysis of thrombocytopenic dengue patients: a cross-sectional study.
BMC Infect Dis. 2017 01 19; 17(1):89.BI

Abstract

BACKGROUND

Dengue virus infection (DVI) is a prevalent and potentially fatal viral disease associated with coagulopathy. So far, the coagulation profile of DVI patients with thrombocytopenia has not been assessed through a viscoelastic test such as rotational thromboelastometry. We aimed to describe the prevalence and characteristics of coagulation abnormalities in dengue fever outpatients with thrombocytopenia, addressed by both rotational thromboelastometry and conventional coagulation tests.

METHODS

This was a cross-sectional study conducted between April 6th and May 5th 2015 in São Paulo, Brazil during a dengue outbreak. Thromboelastometry (ROTEM®) and the conventional coagulation tests prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), thrombin time (TT), platelet count and fibrinogen levels were performed in 53 patients with DVI and thrombocytopenia.

RESULTS

Despite a median interquartile range (IQR) platelet count of 77 (63-88) x 109/L in DVI patients, conventional coagulation tests and plasma fibrinogen levels were within the normal range. Subjects demonstrated hypocoagulability in 71.7% (38/53) in INTEM and 54.7% (29/53) in EXTEM DVI patients. FIBTEM analyses detected only 5.7% (3/53) with hypocoagulability among this population. The median (IQR) clotting time (CT), clot formation time (CFT) and maximum clot firmness (MCF) on INTEM were, respectively, 177 (160-207) sec, 144 (108-178) sec and 48 (42-52) mm. On EXTEM, median (IQR) CT, CFT and MCF were, respectively, 69 (65-78) sec, 148 (126-198) sec and 49 (44-55) mm. Median (IQR) MCF on FIBTEM was 15 (13-18) mm.

CONCLUSION

Thromboelastometry impairment is highly prevalent in DVI patients with thrombocytopenia, particularly in INTEM and EXTEM analyses, while standard coagulation tests are normal in this setting. Clinical implications remain to be established.

Authors+Show Affiliations

Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil. felipe.piza@einstein.br.Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil. Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° andar, São Paulo, CEP: 05651-901, Brazil.Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28103832

Citation

Piza, Felipe Maia de Toledo, et al. "Thromboelastometry Analysis of Thrombocytopenic Dengue Patients: a Cross-sectional Study." BMC Infectious Diseases, vol. 17, no. 1, 2017, p. 89.
Piza FM, Corrêa TD, Marra AR, et al. Thromboelastometry analysis of thrombocytopenic dengue patients: a cross-sectional study. BMC Infect Dis. 2017;17(1):89.
Piza, F. M., Corrêa, T. D., Marra, A. R., Guerra, J. C., Rodrigues, R. D., Villarinho, A. A., de Aranda, V. F., Shiramizo, S. C., de Lima, M. R., Kallas, E. G., & Cavalcanti, A. B. (2017). Thromboelastometry analysis of thrombocytopenic dengue patients: a cross-sectional study. BMC Infectious Diseases, 17(1), 89. https://doi.org/10.1186/s12879-017-2204-4
Piza FM, et al. Thromboelastometry Analysis of Thrombocytopenic Dengue Patients: a Cross-sectional Study. BMC Infect Dis. 2017 01 19;17(1):89. PubMed PMID: 28103832.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thromboelastometry analysis of thrombocytopenic dengue patients: a cross-sectional study. AU - Piza,Felipe Maia de Toledo, AU - Corrêa,Thiago Domingos, AU - Marra,Alexandre Rodrigues, AU - Guerra,João Carlos Campos, AU - Rodrigues,Roseny Dos Reis, AU - Villarinho,Andrea Aparecida Rocco, AU - de Aranda,Valdir Fernandes, AU - Shiramizo,Sandra Christina Pereira Lima, AU - de Lima,Maria Roza de Jesus, AU - Kallas,Esper Georges, AU - Cavalcanti,Alexandre Biasi, Y1 - 2017/01/19/ PY - 2016/07/15/received PY - 2017/01/14/accepted PY - 2017/1/21/entrez PY - 2017/1/21/pubmed PY - 2017/7/8/medline SP - 89 EP - 89 JF - BMC infectious diseases JO - BMC Infect. Dis. VL - 17 IS - 1 N2 - BACKGROUND: Dengue virus infection (DVI) is a prevalent and potentially fatal viral disease associated with coagulopathy. So far, the coagulation profile of DVI patients with thrombocytopenia has not been assessed through a viscoelastic test such as rotational thromboelastometry. We aimed to describe the prevalence and characteristics of coagulation abnormalities in dengue fever outpatients with thrombocytopenia, addressed by both rotational thromboelastometry and conventional coagulation tests. METHODS: This was a cross-sectional study conducted between April 6th and May 5th 2015 in São Paulo, Brazil during a dengue outbreak. Thromboelastometry (ROTEM®) and the conventional coagulation tests prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), thrombin time (TT), platelet count and fibrinogen levels were performed in 53 patients with DVI and thrombocytopenia. RESULTS: Despite a median interquartile range (IQR) platelet count of 77 (63-88) x 109/L in DVI patients, conventional coagulation tests and plasma fibrinogen levels were within the normal range. Subjects demonstrated hypocoagulability in 71.7% (38/53) in INTEM and 54.7% (29/53) in EXTEM DVI patients. FIBTEM analyses detected only 5.7% (3/53) with hypocoagulability among this population. The median (IQR) clotting time (CT), clot formation time (CFT) and maximum clot firmness (MCF) on INTEM were, respectively, 177 (160-207) sec, 144 (108-178) sec and 48 (42-52) mm. On EXTEM, median (IQR) CT, CFT and MCF were, respectively, 69 (65-78) sec, 148 (126-198) sec and 49 (44-55) mm. Median (IQR) MCF on FIBTEM was 15 (13-18) mm. CONCLUSION: Thromboelastometry impairment is highly prevalent in DVI patients with thrombocytopenia, particularly in INTEM and EXTEM analyses, while standard coagulation tests are normal in this setting. Clinical implications remain to be established. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/28103832/Thromboelastometry_analysis_of_thrombocytopenic_dengue_patients:_a_cross_sectional_study_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-017-2204-4 DB - PRIME DP - Unbound Medicine ER -