Viscoelastic testing (TEG/ROTEM) is increasingly used in perioperative coagulation management. A ROTEM result shows prolonged CFT (clot formation time), reduced alpha-angle, and low MCF (maximum clot firmness) with a normal CT (clotting time). What does this pattern indicate?

• A Factor deficiency (prolonged CT expected in pure factor deficiency)
• B Hyperfibrinolysis (increased LI30/ML)
• C Platelet dysfunction or thrombocytopenia causing poor clot polymerisation ✓
• D Heparin effect (use heparinase ROTEM to confirm)

Explanation

In ROTEM, clotting time (CT) reflects initiation of coagulation (factor pathway), while CFT and alpha-angle reflect clot formation speed (mainly fibrinogen and platelets). MCF reflects final clot strength (platelets + fibrinogen). A prolonged CFT, reduced alpha-angle, and low MCF with normal CT points to platelet dysfunction or thrombocytopenia — the initiation phase is intact (normal CT) but the propagation and final clot strength are impaired due to inadequate platelet contribution. Pure factor deficiency would prolong CT. Hyperfibrinolysis would show increased lysis index (LI30 <85% or ML >15%).

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.