DIAGNOSTIC VALUE OF NONACTIVATED THROMBOELASTOMETRY IN OBSTETRIC AND GYNECOLOGICAL PRACTICE WITH A FOCUS ON RARE COAGULOPATHIES

The quality of clinical laboratory tests is characterized by clinical informative value, which is one of the main parameters. Activator tests and nonactivated thromboelastometry (NATEM) are performed with the ROTEM Delta thromboelastometer. Activator tests provide rapid assessment of fibrinogen activity, coagulation factors, fibrinolysis and the effect of heparin on clot formation, which determines their high clinical information value for Point Оf Care evaluation of coagulation and targeted therapy for massive bleeding. NATEM is more commonly used in clinical practice due to its ease of implementation and low cost; however, there is a lack of convincing evidence of its clinical value in identifying the causes of bleeding, particularly in obstetrics and gynecology. NATEM parameters were shown to have high sensitivity to hypercoagulability and low sensitivity to detect von Willebrand disease, F:VII and F:XII deficiency in patients with obstetric and gynecological coagulopathy. In the presence of lupus anticoagulant, NATEM parameters do not reflect prothrombotic risk, but are instead in the area of hypocoagulation. In hemorrhage, NATEM parameters are multidirectional and fail to differentiate the cause of the hemorrhagic syndrome. Conclusion: NATEM has low diagnostic value for the detection of coagulopathy in obstetric and gynecological patients. NATEM parameters are highly sensitive to hypercoagulation, which may mask clotting factor deficiency. NATEM does not provide diagnostic evidence of the cause of coagulopathic bleeding; activator tests should be performed for this purpose. © 2025 Elsevier B.V., All rights reserved.