{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T14:59:30Z","timestamp":1766069970898,"version":"3.48.0"},"reference-count":34,"publisher":"Wiley","issue":"24","license":[{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020648","name":"Royal College of Physicians of Thailand","doi-asserted-by":"publisher","award":["07\u20102565"],"award-info":[{"award-number":["07\u20102565"]}],"id":[{"id":"10.13039\/100020648","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004776","name":"Faculty of Medicine, Chulalongkorn University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004776","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Laboratory Analysis"],"published-print":{"date-parts":[[2025,12]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Periprocedural rotational thromboelastometry (ROTEM) could reduce transfusions while maintaining low bleeding risks in cirrhosis. However, it is unclear whether the benefits arise from higher transfusion thresholds, or ROTEM's ability to detect rebalanced hemostasis.<\/jats:p>\n <\/jats:sec>\n \n Method<\/jats:title>\n This cohort study assessed the correlation between CCTs and ROTEM by analyzing blood samples from cirrhotic patients scheduled for elective endoscopy. Additionally, anticoagulant protein levels were measured to assess whether ROTEM shares the same limitations as CCTs.<\/jats:p>\n <\/jats:sec>\n \n Result<\/jats:title>\n \n The study included 133 patients, 57% male, with a mean age of 62\u2009years. High correlations were observed between prothrombin time ratio (PT\u2010R) and EXTEM\u2010CT (\n r<\/jats:italic>\n \u2009=\u20090.73,\n p<\/jats:italic>\n \u2009<\u20090.01), platelet count and EXTEM\u2010MCF (\n r<\/jats:italic>\n \u2009=\u20090.7,\n p<\/jats:italic>\n \u2009<\u20090.01), fibrinogen and FIBTEM\u2010MCF (\n r<\/jats:italic>\n \u2009=\u20090.78,\n p<\/jats:italic>\n \u2009<\u20090.01), and fibrinogen and EXTEM\u2010MCF (\n r<\/jats:italic>\n \u2009=\u20090.72,\n p<\/jats:italic>\n \u2009<\u20090.01). Only 41.7% of patients with PT\u2010\n R<\/jats:italic>\n \u2009>\u20091.5 had EXTEM\u2010CT exceeding the transfusion threshold (>\u2009110\u2009s), while all patients with PT\u2010\n R<\/jats:italic>\n \u2009>\u20091.8 showed prolonged EXTEM\u2010CT. A platelet count \u2264\u200940.5 \u00d7\u200910\n 9<\/jats:sup>\n \/L was associated with impaired EXTEM\u2010MCF (<\u200940\u2009mm). Patients with EXTEM\u2010CT\u2009>\u2009110\u2009s had significantly lower protein C and antithrombin levels. Endoscopy revealed esophageal varices in 68 (52%) patients, with 23 (34%) requiring band ligation. No bleeding occurred within 2\u2009weeks.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n ROTEM correlates strongly with CCTs and does not overcome their limitations in detecting rebalanced hemostasis. Prophylactic transfusions based solely on abnormal ROTEM or CCTs should be avoided. However, increasing transfusion thresholds to PT\u2010\n R<\/jats:italic>\n \u2009>\u20091.8 and platelet count <\u200940\u2009\u00d7\u200910\n 9<\/jats:sup>\n \/L during active bleeding may help reduce unnecessary transfusions.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/jcla.70130","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T10:05:24Z","timestamp":1764065124000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rotational Thromboelastometry (\n ROTEM<\/scp>\n ) Versus Conventional Coagulation Tests in Cirrhosis: Can We Reduce Plasma Transfusion Without\n ROTEM<\/scp>\n ?"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7470-5340","authenticated-orcid":false,"given":"Nuanrat","family":"Cheerasiri","sequence":"first","affiliation":[{"name":"Center of Excellence in Translational Hematology, Division of Hematology, Department of Medicine, Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital Bangkok Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ratchaneekorn","family":"Jantasing","sequence":"additional","affiliation":[{"name":"Center of Excellence in Translational Hematology, Division of Hematology, Department of Medicine, Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital Bangkok Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rapat","family":"Pittayanon","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital Bangkok Thailand"},{"name":"Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology Chulalongkorn University Bangkok Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7912-1996","authenticated-orcid":false,"given":"Ponlapat","family":"Rojnuckarin","sequence":"additional","affiliation":[{"name":"Center of Excellence in Translational Hematology, Division of Hematology, Department of Medicine, Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital Bangkok Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,25]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1211801"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.12.022"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31646"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.15562"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2021.08.015"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.09.003"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.htct.2020.05.010"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/prca.202300072"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11894\u2010017\u20100585\u20106"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1011170"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation\u20102015.1.243"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.23599"},{"issue":"8","key":"e_1_2_11_14_1","first-page":"513","article-title":"Potential Applications of Thromboelastography in Patients With Acute and Chronic Liver Disease","volume":"8","author":"Stravitz R. 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