Using Rotational Thromboelastometry (ROTEM) to Evaluate Coagulation Status After Intrapleural Recombinant Tissue Plasminogen Activator (rtPA) Administration in Regional Anesthesia

We report a case of a 45-year-old male who underwent thoracotomy for empyema and received multiple doses of intrapleural recombinant tissue plasminogen activator (rtPA). Given the recent administration of rtPA, the acute pain service performed a rotational thromboelastometry (ROTEM) test to assess coagulation before proceeding with regional anesthesia. The ROTEM results indicated normal to hypercoagulable clotting parameters, with a normal extrinsic thromboelastometry (EXTEM) lysis index at 30 minutes, suggesting no systemic effects of rtPA. Based on these findings, a single-shot paravertebral block was successfully performed, and subsequent pain management included a thoracic epidural without complication or evidence of spinal hematoma. This case demonstrates that ROTEM can provide valuable reassurance on coagulation status in patients who have received intrapleural rtPA, helping to assess the safety of regional anesthesia.