TEG® Functional Fibrinogen Analysis May Overestimate Fibrinogen Levels

Ågren, Anna; Wikman, Agneta; Östlund, Anders; Edgren, Gustaf

doi:10.1213/ane.0000000000000172

Cited by 42 publications

(21 citation statements)

References 14 publications

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“…Furthermore, the evaluation of plasma fibrinogen itself is problematic. Functional fibrinogen may be calculated automatically on the basis of clot firmness by eliminating the platelet contribution in viscoelastic tests, but in bleeding surgical patients (17) and in LT after graft reperfusion (18), the calculated value overestimates the value measured by the conventional Clauss method (17,18). The intensity of platelet inhibition also influences the accurate assessment of clot firmness, on which calculations will be based (19).…”

mentioning

confidence: 99%

Impact of Preemptive Fibrinogen Concentrate on Transfusion Requirements in Liver Transplantation: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial

Sabaté

Gutierrez

Beltrán

et al. 2016

American Journal of Transplantation

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mentioning

confidence: 99%

Impact of Preemptive Fibrinogen Concentrate on Transfusion Requirements in Liver Transplantation: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial

Sabaté

Gutierrez

Beltrán

et al. 2016

American Journal of Transplantation

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“…Plasma fibrinogen concentration was measured by Clauss method. 36 PT was converted to INR according to the specific reagents and device characteristics in the lab.…”

Section: Conventional Coagulation Testsmentioning

confidence: 99%

A Comparative Analysis of Functional Fibrinogen Assays using TEG and ROTEM in Trauma Patients Enrolled in the FiiRST Trial

Tien¹,

Peng²,

Nascimento³

et al. 2018

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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Introduction:Given the growing use of both thrombelastography (TEG) and rotational thromboelastometry (ROTEM) in trauma and surgery, it is important to determine whether the two are interchangeable, and how comparable they are to Clauss fibrinogen assay and for clinical use. We recently completed a randomized control trial on early fibrinogen in trauma (the FiiRST trial). The object of this analysis was to evaluate the interchangeability and correlations between TEG and ROTEM functional fibrinogen assays in injured trauma patients. Also, we evaluated their correlation with Clauss fibrinogen and compared their potentials for diagnosis of coagulopathy and use in guided fibrinogen administration. Materials and Methods:The Post-hoc analysis of the coagulation data collected as part of the FiiRST trial. It was a comparative analysis of functional fibrinogen assays using TEG and ROTEM in trauma patients screened for hypotension and need for blood transfusion. TEG and ROTEM tests were also compared with Clauss fibrinogen assay and INR as additional analyses of their clinical use.Results: TEG and ROTEM parameter values were correlated but were significantly different, and their agreement fell outside acceptable limits and thus were not interchangeable. TEG maximum amplitude (MA) and ROTEM maximum clot firmness (MCF) showed closest correlations with Clauss fibrinogen concentration, particularly with ROTEM FIBTEM MCF (r = 0.84; p < 0.001). There were discrepancies between TEG and ROTEM in their detection of coagulation abnormalities, hypofibrinogenemia, and hyperfibrinolysis.Conclusion: TEG and ROTEM fibrinogen assay parameters were associated, especially between TEG MA and ROTEM MCF, showing the strongest correlation, but the parameters were not interchangeable. TEG and ROTEM showed varying extents of correlations with Clauss fibrinogen. Overall, ROTEM parameters exhibited better correlations with Clauss fibrinogen than TEG. Different algorithms for TEG and ROTEM need to be developed for diagnosis of coagulopathy and guided fibrinogen administration in trauma.

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“…FFA and FIBTEM are not interchangeable and there is concern with regards to a residual platelet contribution to the MA of the FFA (Ortmann et al , ). A direct on‐screen conversion of the FFA MA into a functional fibrinogen level in g/l on the TEG ® 5000 has been shown to be to unreliable for clinical use (Agren et al , ).…”

Section: Activators and Additives: The Different Assaysmentioning

confidence: 99%

The place of viscoelastic testing in clinical practice

Hans

Besser

2016

Br J Haematol

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Hellmut Hartert was the first person to exploit the viscoelastic properties of clotting blood to measure blood coagulation in 1948. Since then, the technology has improved, allowing these analyses to be performed as point-of-care tests with immediately-available results. The addition of several activators and inhibitors to the original assay creates a panel of tests able to quantify the different aspects of blood clotting that can rival conventional laboratory assays. However, although much progress has been made, the standardization and validation of these tests still need improvement. Viscoelastic analyses of blood coagulation are mainly used to guide haemostatic therapy in bleeding patients and have proven superior to standard clotting tests in some circumstances. There is potential to extend their use to other areas, such as drug monitoring, and diagnosis and management of congenital bleeding disorders. The forthcoming cartridge-based assays are expected to improve the reliability and usability of viscoelastic assays of blood coagulation but high quality clinical trials remain urgently needed to determine their exact place, benefit and cost effectiveness.

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TEG® Functional Fibrinogen Analysis May Overestimate Fibrinogen Levels

Cited by 42 publications

References 14 publications

Impact of Preemptive Fibrinogen Concentrate on Transfusion Requirements in Liver Transplantation: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial

Impact of Preemptive Fibrinogen Concentrate on Transfusion Requirements in Liver Transplantation: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial

A Comparative Analysis of Functional Fibrinogen Assays using TEG and ROTEM in Trauma Patients Enrolled in the FiiRST Trial

The place of viscoelastic testing in clinical practice

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