The use of ROTEM in Detection of Coagulopathy and Altered Hemostasis in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy.

Abstract

Background: Patients undergoing Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) are at risk of coagulopathy. This study aims to evaluate the potential role of rotational thromboelastometry (ROTEM) in detecting alterations in coagulation during and after CRS/HIPEC.

Methods: A prospective observational study was conducted at a single tertiary care center. All consecutive patients undergoing CRS/HIPEC from April 2021 to December 2022 were enrolled. Participants were monitored using ROTEM, INR, PTT, and Fibrinogen at four time points (pre-incision, post-HIPEC, and on postoperative days 1 and 3).

Results: A total of 35 patients were included. Significant changes were observed from pre-incision to post-HIPEC coagulation parameters: mean fibrinogen decreased from 3.5 g/L to 2.1 g/L and mean INR increased from 1.1 to 2.1, p < 0.05. By postoperative day 3, all parameters had recovered to their pre-incision baselines, with EXTEM ML30 and fibrinogen significantly increased from baseline. Lower pre-incision fibrinogen was significantly associated with increased intra-operative blood loss, p < 0.05. Anesthesiologists reported that intra-operative ROTEM influenced management in 17% of cases (5/30).

Conclusions: CRS/HIPEC is associated with significant changes in the coagulation profile that largely normalize by postoperative day 3. Utilizing ROTEM intraoperatively can help identify patients at risk of intra-operative bleeding and guide transfusion strategies.