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The significant reduction in allogeneic blood product requirements during surgical burn wound excision is a prospective proof of concept that a bleeding management algorithm based on thromboelastometry is efficacious. Hypofibrinogenaemia and hyperfibrinolysis are not significant pathomechanisms of bleeding in this setting and ROTEM(®) helps to avoid unnecessary interventions.

Rotational thromboelastometry ROTEM is available as point-of-care coagulation monitoring in an increasing number of European operating theatres and emergency rooms. The Platelet Mapping Assay has been described as a platelet aggregation assay for thromboelastography TEG. The aim of this experimental trial was to evaluate feasibility of the Platelet Mapping Assay on the ROTEM test system. Whole blood was drawn from 22 adult volunteers and patients with and without antiplatelet medication. Platelet aggregability was determined in three whole blood assays: the Platelet Mapping Assay using both activators arachidonic acid (AA) and adenosine diphosphate (ADP) on TEG, its adapted version on ROTEM, and the multiple electrode impedance aggregometer Multiplate. Percent aggregation inhibition results were plotted in a linear regression analysis and correlation was estimated. Sensitivity and specificity for detecting antiplatelet medication were determined. Overall correlations were statistically significant with an r(2) = 0.83 in AA-activated and an r(2) = 0.82 in ADP-activated Platelet Mapping Assay. AA-activated tests and the Multiplate analysis identified aspirin-inhibition in 86% and 100%, respectively. ADP-activated tests and the Multiplate analysis identified clopidogrel-inhibition in 67% and 89%, respectively. Specificity was low both in ROTEM and TEG. Differences in frequency distribution between the results obtained in ROTEM and TEG were not statistically significant. The Platelet Mapping Assay can be performed on the ROTEM. For the perioperative scenario, however, longer test duration and higher costs have to be considered compared to Multiplate analyses.

Non-vitamin K antagonist oral anticoagulants (NOACs), which inhibit thrombin (dabigatran) and factor Xa (rivaroxaban, apixaban, edoxaban) have been introduced in several clinical indications. Although NOACs have a favourable benefit-risk profile and can be used without routine laboratory monitoring, they are associated-as any anticoagulant-with a risk of bleeding. In addition, treatment may need to be interrupted in patients who need surgery or other procedures. The objective of this article, developed by a multidisciplinary panel of experts in thrombosis and haemostasis, is to provide an update on the management of NOAC-treated patients who experience a bleeding episode or require an urgent procedure. Recent advances in the development of targeted reversal agents are expected to help streamline the management of NOAC-treated patients in whom rapid reversal of anticoagulation is required.