Effects of Pneumatic Tube Systems on Next-Generation Viscoelastic Coagulation Test Devices in Septic Patients and Healthy Individuals: Results of the Randomized Controlled VETaPT Trial

Effects of Pneumatic Tube Systems on Next-Generation Viscoelastic Coagulation Test Devices in Septic Patients and Healthy Individuals: Results of the Randomized Controlled VETaPT Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Effects of Pneumatic Tube Systems on Next-Generation Viscoelastic Coagulation Test Devices in Septic Patients and Healthy Individuals: Results of the Randomized Controlled VETaPT Trial Martin Mirus, Erik Buehrer, Oliver Tiebel, Christian Schnabel, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8121734/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Rapid coagulation assessment is essential in critical care to enable timely correction of coagulopathy. Viscoelastic testing (VET) supports this goal but may be affected by mechanical stress during transport by pneumatic tube systems (PTS). As PTS are widely used to expedite sample delivery, evaluating the robustness of next-generation VET and platelet function assays under these conditions is crucial for reliable, time-sensitive diagnostics in intensive care. This study investigated the impact of PTS transport on VET and platelet function testing in healthy individuals and septic patients, including quantitative analysis of acceleration forces. Methods This randomized trial subjected blood samples from 46 healthy volunteers and 45 septic patients to manual and PTS transport. Acceleration was quantified via three-axis accelerometry. Samples were analyzed using ClotPro®, ROTEM®, TEG® PlateletMapping®, and Multiplate®. Primary objective was the difference in test results following both transport modes. As pre-specified in the protocol, logistic regression modeled the probability of a clinically relevant EX-test clotting time (CT) change (≥ 10 s) within each cohort. Given the absence of associations, secondary equivalence analyses (TOST [two one-sided tests] and bootstrap) assessed whether observed effects were within pre-specified bounds. Results Neither logistic regression nor correlation analysis indicated an effect of mechanical stress on variable changes (all ρ 0.01). Across platforms, most viscoelastic and platelet function variables remained within predefined equivalence margins after PTS transport. Exceptions were TEG® PlateletMapping® HKH-R and, by bootstrap, ADP/AA-inhibition. In healthy volunteers, equivalence was confirmed for all variables (TOST p < 0.001). In septic patients, minor shifts remained within clinically acceptable limits, with equivalence confirmed for ClotPro® IN-test CT (± 16 s, p – = 0.036; p + < 0.001), EX-test MCF (± 2 mm, both p < 0.001), ROTEM® INTEM CT (± 16 s, both p < 0.001), Multiplate® TRAP (± 10 U, p– = 0.001; p + < 0.001), and TEG® PlateletMapping® ADP/AA inhibition (± 5%, both p < 0.05). Conclusions Most next-generation viscoelastic and platelet assays are robust to PTS-induced stress. Coagulation diagnostics can include PTS transport without compromising validity. Only selected TEG® PlateletMapping® variables exhibited variability, indicating limited robustness. Trial registration: The study is retrospectively registered with the German Clinical Trials Register (DRKS00036231; https://drks.de/search/de/trial/DRKS00036231/details on 20.02.2025). Health sciences/Biomarkers Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Coagulation Platelet Function Pneumatic Tube System Point-of-Care Sepsis Viscoelastometry Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 19 Mar, 2026 Reviews received at journal 19 Mar, 2026 Reviewers agreed at journal 09 Mar, 2026 Reviewers agreed at journal 01 Mar, 2026 Reviews received at journal 10 Feb, 2026 Reviewers agreed at journal 20 Jan, 2026 Reviewers agreed at journal 30 Dec, 2025 Reviewers invited by journal 08 Dec, 2025 Editor assigned by journal 02 Dec, 2025 Editor invited by journal 28 Nov, 2025 Submission checks completed at journal 19 Nov, 2025 First submitted to journal 19 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8121734","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":557269260,"identity":"9dde3faf-d342-4617-a9a7-ccb38a578896","order_by":0,"name":"Martin 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Randomized Controlled VETaPT Trial","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Coagulation, Platelet Function, Pneumatic Tube System, Point-of-Care, Sepsis, Viscoelastometry","lastPublishedDoi":"10.21203/rs.3.rs-8121734/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8121734/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eRapid coagulation assessment is essential in critical care to enable timely correction of coagulopathy. Viscoelastic testing (VET) supports this goal but may be affected by mechanical stress during transport by pneumatic tube systems (PTS). As PTS are widely used to expedite sample delivery, evaluating the robustness of next-generation VET and platelet function assays under these conditions is crucial for reliable, time-sensitive diagnostics in intensive care. This study investigated the impact of PTS transport on VET and platelet function testing in healthy individuals and septic patients, including quantitative analysis of acceleration forces.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis randomized trial subjected blood samples from 46 healthy volunteers and 45 septic patients to manual and PTS transport. Acceleration was quantified via three-axis accelerometry. Samples were analyzed using ClotPro\u0026reg;, ROTEM\u0026reg;, TEG\u0026reg; PlateletMapping\u0026reg;, and Multiplate\u0026reg;. Primary objective was the difference in test results following both transport modes. As pre-specified in the protocol, logistic regression modeled the probability of a clinically relevant EX-test clotting time (CT) change (\u0026ge;\u0026thinsp;10 s) within each cohort. Given the absence of associations, secondary equivalence analyses (TOST [two one-sided tests] and bootstrap) assessed whether observed effects were within pre-specified bounds.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eNeither logistic regression nor correlation analysis indicated an effect of mechanical stress on variable changes (all ρ\u0026thinsp;\u0026lt;\u0026thinsp;0.5; p\u0026thinsp;\u0026gt;\u0026thinsp;0.01). Across platforms, most viscoelastic and platelet function variables remained within predefined equivalence margins after PTS transport. Exceptions were TEG\u0026reg; PlateletMapping\u0026reg; HKH-R and, by bootstrap, ADP/AA-inhibition. In healthy volunteers, equivalence was confirmed for all variables (TOST p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In septic patients, minor shifts remained within clinically acceptable limits, with equivalence confirmed for ClotPro\u0026reg; IN-test CT (\u0026plusmn;\u0026thinsp;16 s, p\u003csub\u003e\u0026ndash;\u003c/sub\u003e = 0.036; p\u003csub\u003e+\u003c/sub\u003e \u0026lt; 0.001), EX-test MCF (\u0026plusmn;\u0026thinsp;2 mm, both p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), ROTEM\u0026reg; INTEM CT (\u0026plusmn;\u0026thinsp;16 s, both p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Multiplate\u0026reg; TRAP (\u0026plusmn;\u0026thinsp;10 U, p\u0026ndash; = 0.001; p\u0026thinsp;+\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and TEG\u0026reg; PlateletMapping\u0026reg; ADP/AA inhibition (\u0026plusmn;\u0026thinsp;5%, both p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eMost next-generation viscoelastic and platelet assays are robust to PTS-induced stress. Coagulation diagnostics can include PTS transport without compromising validity. Only selected TEG\u0026reg; PlateletMapping\u0026reg; variables exhibited variability, indicating limited robustness.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e\u003cp\u003eThe study is retrospectively registered with the German Clinical Trials Register (DRKS00036231; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://drks.de/search/de/trial/DRKS00036231/details\u003c/span\u003e\u003cspan address=\"https://drks.de/search/de/trial/DRKS00036231/details\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e on 20.02.2025).\u003c/p\u003e","manuscriptTitle":"Effects of Pneumatic Tube Systems on Next-Generation Viscoelastic Coagulation Test Devices in Septic Patients and Healthy Individuals: Results of the Randomized Controlled VETaPT Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-10 16:00:49","doi":"10.21203/rs.3.rs-8121734/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-19T10:38:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-19T05:25:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"299101547122361065970951493787547624827","date":"2026-03-10T02:43:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"170130184260016304047706182256684500361","date":"2026-03-01T11:39:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-11T04:12:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"307024781179605946904613398011083583588","date":"2026-01-21T00:36:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"34389138118053569399312041642688237974","date":"2025-12-30T16:18:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-08T09:15:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-02T09:25:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-28T07:20:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-19T12:30:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-11-19T12:22:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"608f5d96-7cc6-4bad-8162-c841fefe1f78","owner":[],"postedDate":"December 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":59309021,"name":"Health sciences/Biomarkers"},{"id":59309022,"name":"Health sciences/Diseases"},{"id":59309023,"name":"Health sciences/Health care"},{"id":59309024,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-05-21T06:09:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-10 16:00:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8121734","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8121734","identity":"rs-8121734","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}