%0 Journal Article
%T Thromboelastography in acute immunologic reactions: a prospective pilot study.
%A Kienbacher CL
%A Schoergenhofer C
%A Ruzicka G
%A Grafeneder J
%A Hufnagl C
%A Jilma B
%A Schwameis M
%A Herkner H
%J Res Pract Thromb Haemost
%V 8
%N 4
%D 2024 May
%M 38974798
%F 5.953
%R 10.1016/j.rpth.2024.102425
%X <B>UNASSIGNED: </B>Biomarkers of fibrinolysis are elevated during acute immunologic reactions (allergic reactions and angioedema), although it is unclear whether fibrinolysis is associated with disease severity.<BR><B>UNASSIGNED: </B>We investigated a possible association between maximum lysis (ML) measured by thromboelastography and the severity of acute immunologic reactions.<BR><B>UNASSIGNED: </B>We recruited patients with acute immunologic reactions at a high-volume emergency department. Clinical disease severity at presentation and at the end of the emergency department stay was assessed using a 5-grade scale, ranging from local symptoms to cardiac arrest. We determined ML on admission by thromboelastography (ROTEM's extrinsic [EXTEM], and aprotinin [APTEM] tests), expressed as ML%. Hyperfibrinolysis was defined as an ML of >15% in EXTEM, which was reversed by adding aprotinin (APTEM). We used exact logistic regression to investigate an association between ML% and disease severity (grades 1 and 2 [mild] vs 3-5 [severe]) and between hyperfibrinolysis and disease severity.<BR><B>UNASSIGNED: </B>We included 31 patients (71% female; median age, 52 [IQR, 35-58] years; 10 [32%] with a severe reaction). ML% was higher in patients with severe symptoms (21 [IQR, 12-100] vs 10 [IQR, 4-17]). Logistic regression found a significant association between ML% and symptom severity (odds ratio, 1.07; 95% CI, 1.01-1.21; P = .003). Hyperfibrinolysis was detected in 6 patients and found to be associated with severe symptoms (odds ratio, 17.59; 95% CI, 1.52-991.09; P = .02). D-dimer, tryptase, and immunoglobulin E concentrations increased with the severity of immunologic reactions.<BR><B>UNASSIGNED: </B>ML, quantified by thromboelastography, is associated with the severity of acute immunologic reactions.