Viscoelastic hemostatic fibrinogen assays detect fibrinolysis early

Abstract

Purpose Viscoelastic hemostatic assays are emerging as the standard-of-care in the early detection of post-injury coagulopathy. TEG and ROTEM are most commonly used. Although similar in technique, each uses different reagents, which may affect their sensitivity to detect fibrinolysis. Therefore, the purpose of this study is to determine the ability of each device to detect fibrinolysis. Methods TEG (Rapid, Kaolin, Functional Fibrinogen) and ROTEM (EXTEM, INTEM, FIBTEM) were run simultaneously on normal blood as well as blood containing tPA from healthy volunteers (n = 10). A two-tailed, paired t-test and ANOVA were used to determine the significance between parameters obtained from normal blood and blood with tPA, and individual TEG and RO-TEM assays, respectively. Results TEG detected significant changes in clot strength and 30-min lysis after the addition of tPA (p < 0.0001). All ROTEM assays detected changes in the 30-min lysis (p < 0.0001), but only INTEM detected changes in clot strength (p < 0.05). Kaolin and Rapid TEG assays detected greater changes in clot strength and lysis, but INTEM and EXTEM had decreased lysis onset times compared to TEG (p < 0.001). Functional Fibrinogen and FIBTEM assays detected lysis sooner than other TEG/ROTEM assays, and were comparable. Conclusions TEG assays detect greater changes in clot strength compared to ROTEM. Despite this, Functional Fibrinogen and FIBTEM assays detect fibrinolysis sooner than their corresponding intrinsic and extrinsic assays. Therefore, fibrinogen assays should be employed in actively bleeding trauma patients in order to provide timely antifibrinolytic therapy.

FIBTEM Improves the Sensitivity of Hyperfibrinolysis Detection in Severe Trauma Patients: A Retrospective Study Using Thromboelastometry

“…Several studies have usedthe FIBTEM test in trauma patients 3,24,25 . Schöchl et al reported that FIBTEM MCF and FIBTEM A10 had a high predictive value for MT in trauma patients 3 .…”

Tissue injury suppresses fibrinolysis after hemorrhagic shock in nonhuman primates (rhesus macaque)

“…20 Additionally, impaired platelet function has been correlated to increased sensitivity to tPA. 21 Furthermore, there is evidence that FIBTEM, and its thromboelastography (TEG) correlate, namely, functional fibrinogen, detect clot lysis sooner than the EXTEM test 22 and increased sensitivity to hyperfibrinolysis has been shown in the FIBTEM versus EXTEM test in patients undergoing liver transplant. 23 Therefore, in the current study, it is plausible that the resistance to fibrinolysis observed was in part mediated by platelet function, and that cytochalasin-D–mediated platelet inhibition in the FIBTEM assay revealed differences in fibrinolytic activity among injury groups.…”

The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management

“…Furthermore, Ichikawa et al demonstrated that an anti-Xa activity below 0.2 U/ml corresponding to a CT IN /CT HEP -ratio below 1.25 was not associated with increased postoperative mediastinal blood loss. In contrast, protamine overdose is not only associated with an elusively prolonged ACT (inhibition of factor V activation), [105,[142][143][144][145][146]153,157,195]: Prophylactic administration of TXA can be given within 3 h after trauma or delivery [142][143][144]195]. Continuous infusion of TXA can be performed in trauma [142][143][144].…”