Nonactivated thromboelastometry able to detect fibrinolysis in contrast to activated methods (EXTEM, INTEM) in a bleeding patient

Durila, Miroslav

doi:10.1097/mbc.0000000000000479

Cited by 18 publications

(22 citation statements)

References 6 publications

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“…25,26 27 Data suggest that the NATEM method is more sensitive to changes in coagulation than the activated counterparts. 28 The parameters of clot formation defined by ROTEM are CT, clot formation time (CFT), maximum clot firmness (MCF), and the clot lysis index. 26 The TGA is usually triggered by tissue factor (TF) (extrinsic pathway) or FXIa (intrinsic pathway), leading to thrombin generation, which is monitored over time.…”

Section: Current Methods In the Coagulation Laboratorymentioning

confidence: 99%

Laboratory Monitoring in Emicizumab-Treated Persons with Hemophilia A

et al. 2019

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Hemophilia A (HA) is an X-linked hereditary bleeding disorder caused by deficiency of coagulation factor (F) VIII activity. One of the greatest complications in the treatment of HA is the development of neutralizing alloantibodies, known as FVIII inhibitors. HA patients who develop FVIII inhibitors have limited treatment options available to them and experience greater disease- and treatment-related burdens than HA patients without FVIII inhibitors. Emicizumab, a recently approved bispecific monoclonal antibody, mimics the function of FVIIIa by bridging FIXa and FX to restore effective hemostasis. Although emicizumab and FVIII show some functional similarities, several key differences influence the results of standard laboratory assays when conducted in the presence of emicizumab, and can result in a misleading interpretation of coagulation assays in emicizumab-treated patients. Here, we discuss current laboratory monitoring methods, including activated partial thromboplastin time, FVIII one-stage clotting assays, FVIII chromogenic assays, and global coagulations assays; address why these conventional methods may be inappropriate for monitoring of HA patients receiving emicizumab; and suggest alternative methods applicable to monitoring HA treatment in an evolving treatment landscape.

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Section: Current Methods In the Coagulation Laboratorymentioning

confidence: 99%

Laboratory Monitoring in Emicizumab-Treated Persons with Hemophilia A

et al. 2019

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“…Raza et al raised the suspicion that ROTEM is simply insensitive until fibrinolysis activation reaches a certain threshold (18). The lack of sensitivity of ROTEM for detecting moderate hyperfibrinolysis with clinical impact in critically ill patients was also described by Durila (19). In a study using thrombelastography in trauma patients, Chapman demonstrated that lower thresholds than the accepted normal upper bound of lysis index are associated with worse outcomes and suggested that clinically relevant threshold for defining hyperfibrinolysis might be lower than the actual standard definition (20).…”

Section: Discussion Discussionmentioning

confidence: 95%

Assessment of Hyperfibrinolysis in Cirrhotic Patients Undergoing Orthotopic Liver Transplantation. A Retrospective Observational Study

Scărlătescu¹,

Buruiana²,

Droc³

et al. 2017

JTMR

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Introduction: Prophylactic antifibrinolytics are recommended for patients at risk to develop significant hyperfibrinolysis during liver transplantation, identified by the preoperative thromboelastometry. Even with this approach, postreperfusion hyperfibrinolysis is frequent, often leading to increased bleeding and transfusion requirements.The aim of this study was to assess hyperfibrinolysis and to predict postreperfusion hyperfibrinolysis based on preoperative standard coagulation tests (SCTs) and thromboelastometry in liver transplant patients without an indication for antifibrinolytic prophylaxis and/or therapy until graft reperfusion. Methods: The study group included cirrhotic patients undergoing orthotopic liver transplantation. Preoperative and at 10 minutes after graft reperfusion, the following data were recorded for each patient: SCTs, complete blood counts and rotation thromboelastometry (ROTEM®, TEM International GmbH, Munich, Germany). From ROTEM measurements we used standard parameters and indices calculated from the first derivative of the clot firmness curve.Hyperfibrinolysis was defined as maximum lysis >15% in EXTEM or by an increase in MCF in APTEM compared to EXTEM (DMCF) more than 7% of EXTEM MCF. Results: Using ML>15% preoperative and postreperfusion hyperfibrinolysis were identified in 20% and 22 % of the patients and were not correlated with SCTs, fibrinogen levels, platelet number, with clot amplitude or thrombus formation on ROTEM.Using DMCF criteria, preoperative hyperfibrinolysis was present in 34% of the patients and was associated with decreased thrombus formation (AUC, p=0.021) and decreased clot elasticity in EXTEM (p=0.01). When DMCF criteria was used postreperfusion, hyperfibrinolysis was present in 42% of the patients, could not be correlated with preoperative ROTEM standard or derived parameters and was associated with decreased MCF in EXTEM and FIBTEM (p= 0.04 and 0.006) and delayed and decreased thrombus formation. Conclusions: The reported incidence of hyperfibrinolysis in cirrhotic patients before and during liver transplantation depends on the ROTEM-based definition used. The difference between APTEM and EXTEM identifies more patients with hyperfibrinolysis than ML>15% criteria and was associated with a decrease in thrombus formation and elasticity both preoperative and post graft reperfusion.

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“…They require the use of a reagent (recombinant tissue factor and polybrene/ellagic acid respectively) in addition to calcium; as such the results could be influenced and not precisely reflect the hemostatic status of the patient. There are studies, including patients, where EXTEM/INTEM parameters were within normal range although patients were bleeding actively [ 25 ]. On the other hand the NATEM assay is only activated by calcium without a supplemental reagent (star-tem ® reagent).…”

Section: Discussionmentioning

confidence: 99%

Reference Values of Thromboelastometry Parameters in Healthy Term Neonates Using NATEM in Cord Blood Samples

et al. 2022

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Background: ROTEM assay has gained increasing acceptance as a method for rapid and specific coagulation pathway assessment. However, its use in the neonatal population remains limited since reference ranges have not yet been established. Aims: (1) to determine reference ranges for healthy term neonates of ROTEM parameters using non-activated assay (NATEM) in cord blood samples; (2) to assess whether delivery mode, gender, gestational age, birth weight and blood group (ABO and Rhesus) of the neonate, coagulation disorder and anticoagulant medication of the mother have an impact on NATEM parameters. Methods: NATEM assay was conducted in cord blood samples of 189 term neonates without any medical history. Results: Reference ranges (2.5th and 97.5th percentiles) are established for clotting time (CT), clot formation time (CFT), α-angle, clot amplitude at 5, 10 and 20 min (A5, A10, A20), maximum clot firmness (MCF), lysis index at 30 and 60 min (LI30, LI60, %) and maximum clot elasticity (MCE). Reference ranges for NATEM are CT 182–499 s, CFT 63–176 s, α-angle 58–78°, A5 28–52 mm, A10 37–61 mm, A20 42–66 mm, MCF 43–67 mm, LI30 97–100%, LI60 87–98% and MCE 75–203. Male neonates appear to be more hypocoagulable than females. Conclusions: We demonstrate reference ranges for healthy term neonates in NATEM assay that could be used as a reference group for future studies of neonates with an underlying pathology.

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Nonactivated thromboelastometry able to detect fibrinolysis in contrast to activated methods (EXTEM, INTEM) in a bleeding patient

Cited by 18 publications

References 6 publications

Laboratory Monitoring in Emicizumab-Treated Persons with Hemophilia A

Laboratory Monitoring in Emicizumab-Treated Persons with Hemophilia A

Assessment of Hyperfibrinolysis in Cirrhotic Patients Undergoing Orthotopic Liver Transplantation. A Retrospective Observational Study

Reference Values of Thromboelastometry Parameters in Healthy Term Neonates Using NATEM in Cord Blood Samples

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