Comparison of point-of-care thrombelastography versus conventional coagulation tests in the emergency department management of trauma

Jeger, Victor; Willi, Sandra; Liu, T; Omert, Laurel; Orr, Adrian W.; Popovsky, MA; Zimmermann, Heinz; Exadaktylos, A.

doi:10.1186/cc9858

Cited by 3 publications

(5 citation statements)

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“…Mean Glasgow Coma Scale scores ranged from 11 to 14 but were reported in only six studies. [65][66][67][72][73][74] All studies [64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81] performed VE testing on admission. Three studies 64,71,72 evaluated TEG as a whole with a positive result based on a combination of different TEG parameters.…”

Section: Study Detailsmentioning

confidence: 99%

“…Fifteen prediction studies [64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81] No multivariate analysis ED, emergency department; FAST, focused assessment for the sonography of trauma; ISS, injury sensitivity score; n, number enrolled; NR, not reported; PRBC, packed red blood cell. a Studies reported only as abstracts.…”

Section: How Well Do Viscoelastic Devices Predict Relevant Clinical Omentioning

confidence: 99%

“…We included 11 RCTs (13 publications) 35,46-57 evaluating ROTEM and TEG in cardiac surgery patients; as no RCTs evaluating Sonoclot were identified, we also included three prediction studies [58][59][60] that evaluated Sonoclot. We included one ongoing RCT, 61,62 one controlled clinical trial (CCT) 63 and 15 prediction studies (18 publications) [64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81] in trauma patients, and two prediction studies 82,83 in women with PPH.…”

Section: Investigation Of Heterogeneitymentioning

confidence: 99%

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Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and cost-effectiveness analysis

Whiting

Westwood

et al. 2015

Health Technol Assess

255

241

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BackgroundPatients with substantive bleeding usually require transfusion and/or (re-)operation. Red blood cell (RBC) transfusion is independently associated with a greater risk of infection, morbidity, increased hospital stay and mortality. ROTEM (ROTEM®Delta, TEM International GmbH, Munich, Germany;www.rotem.de), TEG (TEG®5000 analyser, Haemonetics Corporation, Niles, IL, USA;www.haemonetics.com) and Sonoclot (Sonoclot®coagulation and platelet function analyser, Sienco Inc., Arvada, CO) are point-of-care viscoelastic (VE) devices that use thromboelastometry to test for haemostasis in whole blood. They have a number of proposed advantages over standard laboratory tests (SLTs): they provide a result much quicker, are able to identify what part of the clotting process is disrupted, and provide information on clot formation over time and fibrinolysis.ObjectivesThis assessment aimed to assess the clinical effectiveness and cost-effectiveness of VE devices to assist with the diagnosis, management and monitoring of haemostasis disorders during and after cardiac surgery, trauma-induced coagulopathy and post-partum haemorrhage (PPH).MethodsSixteen databases were searched to December 2013: MEDLINE (OvidSP), MEDLINE In-Process and Other Non-Indexed Citations and Daily Update (OvidSP), EMBASE (OvidSP), BIOSIS Previews (Web of Knowledge), Science Citation Index (SCI) (Web of Science), Conference Proceedings Citation Index (CPCI-S) (Web of Science), Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA) database, Latin American and Caribbean Health Sciences Literature (LILACS), International Network of Agencies for Health Technology Assessment (INAHTA), National Institute for Health Research (NIHR) HTA programme, Aggressive Research Intelligence Facility (ARIF), Medion, and the International Prospective Register of Systematic Reviews (PROSPERO). Randomised controlled trials (RCTs) were assessed for quality using the Cochrane Risk of Bias tool. Prediction studies were assessed using QUADAS-2. For RCTs, summary relative risks (RRs) were estimated using random-effects models. Continuous data were summarised narratively. For prediction studies, the odds ratio (OR) was selected as the primary effect estimate. The health-economic analysis considered the costs and quality-adjusted life-years of ROTEM, TEG and Sonoclot compared with SLTs in cardiac surgery and trauma patients. A decision tree was used to take into account short-term complications and longer-term side effects from transfusion. The model assumed a 1-year time horizon.ResultsThirty-one studies (39 publications) were included in the clinical effectiveness review. Eleven RCTs (n = 1089) assessed VE devices in patients undergoing cardiac surgery; six assessed thromboelastography (TEG) and five assessed ROTEM. There was a significant reduction in RBC transfusion [RR 0.88, 95% confidence interval (CI) 0.80 to 0.96; six studies], platelet transfusion (RR 0.72, 95% CI 0.58 to 0.89; six studies) and fresh frozen plasma to transfusion (RR 0.47, 95% CI 0.35 to 0.65; five studies) in VE testing groups compared with control. There were no significant differences between groups in terms of other blood products transfused. Continuous data on blood product use supported these findings. Clinical outcomes did not differ significantly between groups. There were no apparent differences between ROTEM or TEG; none of the RCTs evaluated Sonoclot. There were no data on the clinical effectiveness of VE devices in trauma patients or women with PPH. VE testing was cost-saving and more effective than SLTs. For the cardiac surgery model, the cost-saving was £43 for ROTEM, £79 for TEG and £132 for Sonoclot. For the trauma population, the cost-savings owing to VE testing were more substantial, amounting to per-patient savings of £688 for ROTEM compared with SLTs, £721 for TEG, and £818 for Sonoclot. This finding was entirely dependent on material costs, which are slightly higher for ROTEM. VE testing remained cost-saving following various scenario analyses.ConclusionsVE testing is cost-saving and more effective than SLTs, in both patients undergoing cardiac surgery and trauma patients. However, there were no data on the clinical effectiveness of Sonoclot or of VE devices in trauma patients.Study registrationThis study is registered as PROSPERO CRD42013005623.FundingThe NIHR Health Technology Assessment programme.

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Section: Study Detailsmentioning

confidence: 99%

Section: How Well Do Viscoelastic Devices Predict Relevant Clinical Omentioning

confidence: 99%

Section: Investigation Of Heterogeneitymentioning

confidence: 99%

See 1 more Smart Citation

Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and cost-effectiveness analysis

Whiting

Westwood

et al. 2015

Health Technol Assess

255

241

View full text Add to dashboard Cite

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“…High rates of thrombosis have been reported in cancers other than prostate cancer, such as pancreatic, colorectal, ovarian cancer, and malignant gliomas. [13][14][15][16][17] However, 1 to 2% of prostate cancer patients are reported to be at risk of VTE, which may be three times greater than in the general population. 18 Tumorinduced hypercoagulability and vascular injury may be a triggering factor, while cancer treatments and surgery may exasperate these conditions.…”

Section: Prothrombotic Properties Of Prostate Cancermentioning

confidence: 99%

“…[37][38][39] Currently, few studies have compared TEG and CCT. [14][15][16]40 Some of these comparisons have indicated TEG usefulness and accuracy for some patients' populations. Some clinical trials have taken place with no results posted yet, 17,41 but none of these studies and trials were particularly concerned with the cancer patients.…”

Section: Thromboelastography Versus Conventional Tools In Assessing H...mentioning

confidence: 99%

Hypercoagulability and Thrombosis Risk in Prostate Cancer: The Role of Thromboelastography

Fainchtein

Tera

Kearn

et al. 2022

Semin Thromb Hemost

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Thrombosis is one of the leading causes of death in cancer. Cancer-induced hypercoagulable state contributes to thrombosis and is often overlooked. Prostate cancer may not be of high thrombogenic potential compared with other cancers, but its high prevalence brings it into focus. Pathological evidence for venous thromboembolisms (VTEs) in prostate cancer exists. Factors such as age, comorbidities, and therapies increase the VTE risk further. There is a need to systematically identify the risk of VTE in regard to patient-, cancer-, and treatment-related factors to risk stratify patients for better-targeted and individualized strategies to prevent VTE. Sensitive tests to enable such risk assessment are urgently required. There is sufficient evidence for the utility of thromboelastography (TEG) in cancer, but it is not yet part of the clinic and there is only limited data on the use of TEG in prostate cancer. One study revealed that compared with age-matched controls, 68.8% of prostate cancer patients demonstrated hypercoagulable TEG parameters. The absence of clinical guidelines is a limiting factor in TEG use in the cancer population. Cancer heterogeneity and the unique cancer-specific microenvironment in each patient, as well as determining the hypercoagulable state in each patient, are added limitations. The way forward is to combine efforts to design large multicenter studies to investigate the utility and clinical effectiveness of TEG in cancer and establish longitudinal studies to understand the link between hypercoagulable state and development of thrombosis. There is also a need to study low thrombogenic cancers as well as high thrombogenic ones. Awareness among clinicians and understanding of test applicability and interpretation are needed. Finally, expert discussion is critical to identify the investigation priorities.

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Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) for trauma‑induced coagulopathy in adult trauma patients with bleeding

Hunt

Stanworth

Curry

et al. 2015

Cochrane Database of Systematic Reviews

183

150

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Comparison of point-of-care thrombelastography versus conventional coagulation tests in the emergency department management of trauma

Cited by 3 publications

References 0 publications

Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and cost-effectiveness analysis

Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and cost-effectiveness analysis

Hypercoagulability and Thrombosis Risk in Prostate Cancer: The Role of Thromboelastography

Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) for trauma‑induced coagulopathy in adult trauma patients with bleeding

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