Hypothermia Induced Impairment of Platelets: Assessment With Multiplate vs. ROTEM-An In Vitro Study

• Published in: Frontiers in physiology Vol. 13; p. 852182
• Main Authors: Wallner, Bernd, Schenk, Bettina, Paal, Peter, Falk, Markus, Strapazzon, Giacomo, Martini, Wenjun Z, Brugger, Hermann, Fries, Dietmar
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 29.03.2022
• Subjects: coagulation; hemorrhage; hypothermia; multiplate; Physiology; platelets; rotational thromboelastometry (ROTEM); rotational thromboelastometry (ROTEM); multiplate; hypothermia; coagulation; platelets; hemorrhage
• ISSN: 1664-042X; 1664-042X
• DOI: 10.3389/fphys.2022.852182

This experimental study aimed to identify and characterize hypothermia-associated coagulopathy and to compare changes in mild to severe hypothermia with the quantitative measurement of rotational thromboelastometry (ROTEM) and multiple-electrode aggregometry (MULTIPLATE). Whole blood samples from 18 healthy volunteers were analyzed at the target temperatures of 37, 32, 24, 18, and 13.7°C with ROTEM (ExTEM, InTEM and FibTEM) and MULTIPLATE using the arachidonic acid 0.5 mM (ASPI), thrombin receptor-activating peptide-6 32 µM (TRAP) and adenosine diphosphate 6.4 µM (ADP) tests at the corresponding incubating temperatures for coagulation assessment. Compared to baseline (37°C) values ROTEM measurements of clotting time (CT) was prolonged by 98% (at 18°C), clot formation time (CFT) was prolonged by 205% and the alpha angle dropped to 76% at 13.7°C ( < 0.001). At 24.0°C CT was prolonged by 56% and CFT by 53%. Maximum clot firmness was only slightly reduced by ≤2% at 13.7°C. Platelet function measured by MULTIPLATE was reduced with decreasing temperature ( < 0.001): AUC at 13.7°C -96% (ADP), -92% (ASPI) and -91% (TRAP). Hypothermia impairs coagulation by prolonging coagulation clotting time and by decreasing the velocity of clot formation in ROTEM measurements. MULTIPLATE testing confirms a linear decrease in platelet function with decreasing temperatures, but ROTEM fails to adequately detect hypothermia induced impairment of platelets.