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The impact of different acids on coagulation remains poorly understood. Hydrochloric acid has often been used without critical evaluation. We aimed to investigate the influence of different acids and their concentrations on rotational thromboelastometry (ROTEM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this observational study ten, blood samples were treated with hydrochloric acid (HCl), lactic acid (C\u2083H\u2086O\u2083), phosphoric acid (H\u2083PO\u2084), or dihydrogen phosphate (H\u2082PO\u2084\u207b) to achieve defined pH levels (7.2\u20136.9). Respiratory acidosis was simulated by incubation in a 20% CO\u2082 atmosphere. Five additional samples were exposed to varying acid concentrations. Samples were analyzed using the ROTEM EXTEM assay. Clotting time (CT), clot formation time (CFT), \u03b1-angle, maximum clot firmness (MCF), and maximum lysis (ML) were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All acids exhibited concentration-dependent effects on EXTEM parameters. HCl caused significant reductions in MCF and prolonged CFT, indicating impaired clot firmness and propagation. C\n                      <jats:sub>3<\/jats:sub>\n                      H\n                      <jats:sub>6<\/jats:sub>\n                      O\n                      <jats:sub>3<\/jats:sub>\n                      induced moderate changes, with elevated fibrinolysis at intermediate concentrations. H\u2083PO\u2084 reduced MCF and increased ML, while H\u2082PO\u2084\u207b primarily delayed clotting initiation and markedly inhibited fibrinolysis. CO\u2082-induced acidosis (pH\u2009\u2248\u20097.1) led to reduced fibrinolytic activity without affecting CT or MCF. Across acid types, increasing acidity consistently impaired clotting dynamics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The type of acid inducing acidosis was associated with distinct alterations in ROTEM parameters in vitro. The choice of acid should be carefully considered in experimental models and taken into account when interpreting data. Whether such effects occur in vivo remains uncertain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12959-026-00912-2","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T09:55:16Z","timestamp":1787219716000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of acid selection on thrombelastometric test results - an in-vitro cohort study"],"prefix":"10.1186","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7330-7121","authenticated-orcid":false,"given":"Gerrit U.","family":"Herpertz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Altmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard H.","family":"Rauch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian F.","family":"Weber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon T.","family":"Sch\u00e4fer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greta","family":"Bischof-Westermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"912_CR1","doi-asserted-by":"publisher","first-page":"1434","DOI":"10.1056\/NEJMra1003327","volume":"371","author":"K Berend","year":"2014","unstructured":"Berend K, de Vries APJ, Gans ROB. 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Our research was conducted in accordance with the Declaration of Helsinki.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"SS reports research support from 50 Hz, BMFTR (German ministry for research, technology and space), CSL Behring, Enicor, Fresenius Kabi, German Innovation Fond, Octapharma, TEM Innovations, Werfen as well as speakers\u00b4 honoraria\/ consulting fees from Alexion, CSL Behring and Werfen. None of the aforementioned support is linked to the submitted work.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"77"}}