Diagnostic Performance and Therapeutic Consequence of Thromboelastometry Activated by Kaolin versus  a Panel of Specific Reagents

Abstract

Background: Thromboelastography/metry (TEG; Haemoscope, Niles, IL/ROTEM; Tem International GmbH, Munich, Germany) is increasingly used to guide transfusion therapy. This study investigated the diagnostic performance and therapeutic consequence of using kaolin-activated whole blood compared with a panel of specific TEM-reagents to distinguish: dilutional coagulopathy, thrombocytopenia, hyperfibrinolysis, and heparinization. Methods: Blood was drawn from 11 healthy volunteers. Dilutional coagulopathy was generated by 50% dilution with hydroxyethyl starch 130/0.4 whereas thrombocytopenia (mean platelet count 20 ϫ10 9 /l) was induced using a validated model. Hyperfibrinolysis and heparin contamination were generated by tissue plasminogen activator 2 nM and unfractionated heparin 0.1U/ml, respectively. Coagulation tests were run on ROTEM delta. Results: Kaolin-activated whole blood showed no differences between dilutional coagulopathy and thrombocytopenia (mean clotting time 450 s vs. 516 s, ␣-angle 47.1°vs. 41.5°, maximum clot firmness 35.0 mm vs. 34.2 mm, all P values Ն0.14). Hyperfibrinolysis specifically disclosed an increased maximum lysis (median: 100%, all P values less than 0.001), and heparin induced a distinctly prolonged clotting time (2283 s, all P values less than 0.02). The coagulopathies were readily distinguishable using a panel of TEMreagents. In particular, dilutional coagulopathy was separated from thrombocytopenia using FIBTEM (maximum clot firmness 1.9 mm vs. 11.2 mm, P Ͻ 0.001). The run time of analysis to achieve diagnostic data was shorter applying a panel of TEMreagents. A transfusion algorithm based on kaolin suggested platelets in case of dilutional coagulopathy, whereas an algorithm applying TEM-reagents suggested fibrinogen. Conclusion: Monoanalysis with kaolin was unable to distinguish coagulopathies caused by dilution from that of thrombocytopenia. Algorithms based on the use of kaolin may lead to unnecessary transfusion with platelets, whereas the application of TEM-reagents may result in goal-directed fibrinogen substitution.

Effects of Fibrinogen Concentrate as First-line Therapy during Major Aortic Replacement Surgery

“…[28][29][30] However, consideration is required as to which viscoelastic methods are used: recent data showed that simultaneous performance of several ROTEM assays (e.g., INTEM, EXTEM, FIBTEM, and HEPTEM) is better able to distinguish different coagulopathies than a single kaolin-activated thrombelastography assay. 31 FIBTEM is a viscoelastic test designed to measure firmness of a clot formed in the presence of a platelet inhibitor (i.e., fibrinbased clot firmness). 11,23 Importantly, FIBTEM does not provide a measurement of fibrinogen concentration.…”

Intraoperative Hemorrhage in a Dangerous Placenta Previa Patient-A Case Report

“…The incidence of massive hemorrhage in the placenta previa hemorrhage is very high, [10] the current clinical research presented patients in preoperative need to improve relevant laboratory examinations, including blood routine, coagulation monitoring for transfusion strategy obstetric hemorrhage, Blood Group Test and Transfusion Reaction Examination. Prepare some red blood cell and plasma, set up two good veins at least, the central vein can be built in a better condition, use a variety of methods to evaluate the intraoperative bleeding.…”

“…When the placenta implantation, the uterus scar place is more likely to cause the postpartum hemorrhage, in addition, uterine resection needed in patients with severe hemorrhage which is threatening the lives of mother and baby [7][8][9]. It happens in these persons like older maternal ages (over 35 years), the frequency of pregnancy, history of previous cesarean section and so on [10]. Placenta implantation is a kind of serious complications of placenta which is mainly caused by placental villi penetrating into the myometrium.…”

Management of traumatic haemorrhage – the European perspective

“…Visco-elastic tests are run in whole blood, thus the corpuscular blood constituents are present and the samples do not need any pre-analytic preparation. A bundle of diverse reagents allows for a differentiation of the underlying causes of coagulopathy [24]. Studies revealed that visco-elastic tests have the potential to identify haemostatic deficiencies more accurately and substantially faster than standard coagulation tests [25][26][27][28].…”