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

Abstract

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.

Fibrinogen levels in severe trauma: A preliminary comparison of Clauss Fibrinogen, ROTEM Sigma, ROTEM Delta and TEG 6s assays from the FEISTY pilot randomised clinical trial

“…7 Technical specifications and the interpretation of results have been published extensively for each machine. [8][9][10] The ROTEM ® FIBTEM and TEG ® Functional Fibrinogen assays use different platelet inhibitors to measure the clot strength attributable to fibrinogen polymerisation, with results then reported as amplitudes in millimetres. 4 As a result of differences between the ROTEM ® and TEG ® assays, their results are not interchangeable.…”

“…4 It has been shown that functional fibrinogen levels measured by VHAs and the CFA method correlated well in trauma patients. 10,11 Similarly, TEG ® and ROTEM ® indices have previously been highly correlated, although they cannot be used interchangeably. 10 Most data that exist describing the relationships between indices pertain to the timepoint when trauma patients first arrive in the ED, with few data documenting that the consistency of agreement remains constant throughout trauma patients' hospital stay (i.e., over the hours and days after initial haemostatic resuscitation and damage-control surgery).…”

Could Fibrinogen Concentration Be a Useful Indicator of Cattle Herd Health Status? Approaches to Setting Reference Values

“…This is the reason for the measurement of fibrinogen levels being used as an indicator of pathological conditions. At present, a variety of methods are used to determine the concentration of fibrinogen in blood plasma [11,[14][15][16][17][18][19][20][21][22][23]. Some of them are cheap and simple enough to even be used in field conditions [11,22,23].…”