Rotation thromboelastometry (ROTEM®) stability and reproducibility over time☆

Theusinger, Oliver M.; Nürnberg, Johannes; Asmis, Lars M.; Seifert, Burkhardt; Spahn, Donat R.

doi:10.1016/j.ejcts.2009.07.038

Cited by 125 publications

(110 citation statements)

References 24 publications

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“…Female patients had higher MA levels than males (66.5 vs. 62.8, p < 0.001), which was consistent with Rafiq et al who reported that more female CABG patients presented with TEG-hypercoagulability and in healthy population female sex and older age are associated with hypercoagulability [6,20,21]. It has frequently been reported that women develop more severe strokes and have worse functional outcomes than men after ischemic stroke [22,23].…”

Section: Discussionsupporting

confidence: 79%

Thrombelastography Maximal Clot Strength Could Predict One-Year Functional Outcome in Patients with Ischemic Stroke

Yao¹,

Dong²,

Song³

et al. 2014

Cerebrovasc Dis

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Background: Elevated maximal clot strength, measured by thrombelastography (TEG) maximum amplitude (MA) has been associated with a higher risk for ischemic events in patients with coronary artery diseases. However, it has not been investigated in patients with cerebrovascular diseases. In the current study, we aimed to evaluate the predictive ability of TEG-MA in assessing the risk for ischemic event recurrence and the functional outcome after index ischemic stroke. Methods: This was a prospective observational study. Consecutive eligible patients with acute ischemic stroke were included and followed up for one year. Patients were stratified into tertile groups based on MA levels. TEG-hypercoagulability was deﬁned as an MA of ≥69 mm. Ischemic events were defined as a composite of ischemic stroke, myocardial infarction, or vascular death (excluding hemorrhagic death). The functional outcome was evaluatewd by modified Rankin Scale (mRS). Unfavorable functional outcome was defined as mRS ≥2. Results: Two hundred and eleven patients were enrolled with 27 lost to follow-up at one year contact. At baseline, 38 (18.0%) patients were TEG-hypercoagulopathy after the treatment of antiplatelets. Patients with higher tertile of MA were more likely to be females, and had lower hemoglobin levels, higher platelet counts, higher fibrinogen levels, higher white blood cell counts, as well as higher ESR and hsCRP levels. Patients in the third tertile group were more likely to have intracranial artery stenosis and large-vessel subtype stroke than those in the other two groups. Higher tertile of MA was also related to stroke severity in acute phase (higher NIHSS scores on admission and longer in-hospital stay). At one year of follow-up, a higher percentage of unfavorable functional outcome and a non-significant trend of higher ischemic event rate were observed in higher MA tertile groups. Multivariate logistic analysis revealed that higher MA level (OR = 1.192, p = 0.022) was an independent predictor for unfavorable one-year functional outcome. Other independent predictors included old age (OR = 1.119, p = 0.001), diabetes mellitus (DM) (OR = 4.280, p = 0.014), previous ischemic stroke/TIA history (OR = 4.953, p = 0.008), and higher NIHSS scores on admission (OR = 1.437, p = 0.001). Conclusions: We found that higher TEG-MA levels could predict an unfavorable functional outcome after index ischemic stroke. Further, large-scale studies are required to investigate the relationship between MA levels and risk of recurrent ischemic events in ischemic stroke patients.

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Section: Discussionsupporting

confidence: 79%

Thrombelastography Maximal Clot Strength Could Predict One-Year Functional Outcome in Patients with Ischemic Stroke

Yao¹,

Dong²,

Song³

et al. 2014

Cerebrovasc Dis

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“…In this study, the diagnosis of thrombocytopenia and dilutional coagulopathy was possible using the A10, which is supported by recent findings that more than 98% of the final MCF was reached after 10 min runtime in patients scheduled for nonemergent surgery. 42 Furthermore, this also corresponds to clinical observations in noncardiac surgery where A10 was found suitable for fast interpretation of thromboelastometric analysis.# Several study limitations merit attention. The current study was performed on modeled coagulopathies in WB.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2011

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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.

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“…With INTEM, coagulation is initiated by contact activator leading to intrinsic pathway activation. The inhibition of the platelets by cytochalasin D in the FIBTEM test shows the fibrinogen clotting which corresponds to fibrinogen plasma levels and can be visualized [16,17]. Furthermore the amount of factor XIII plays a role regarding the maximal amplitude of this test [18].…”

Section: Clot Formation In Whole Blood Thromboelastography and Rotatimentioning

confidence: 99%

Point of Care and Factor Concentrate-Based Coagulation Algorithms

Theusinger

Stein

Levy

2015

Transfus Med Hemother

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In the last years it has become evident that the use of blood products should be reduced whenever possible. There is increasing evidence regarding serious adverse events, including higher mortality and morbidity, related to transfusions. The use of point of care (POC) devices integrated in algorithms is one of the important mechanisms to limit blood product exposure. Any type of algorithm, especially the POC-based ones, allows goal-directed transfusions of blood products and even better targeted factor concentrate substitutions. Different types of algorithms in different surgical settings (cardiac surgery, trauma, liver surgery etc.) have been established with growing interest in their use as they offer objective therapy for management and reduction of blood product use. The use of POC devices with evidence-based algorithms is important in the bleeding patient independent of its origin (traumatic vs. surgical). The use of factor concentrates compared to the classical blood products can be cost-saving, beneficial for the patient, and in agreement with the WHO-requested standard of care. The empiric and uncontrolled use of blood products such as fresh frozen plasma, red blood cells, and platelets without POC monitoring should no longer be followed with regard to actual evidence in literature. Furthermore, the use of factor concentrates may provide better outcomes and potential for cost saving.

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Rotation thromboelastometry (ROTEM®) stability and reproducibility over time☆

Abstract: ROTEM yields stable results over 120 min with a minimal variability on the same ROTEM device. However, small but significant differences between ROTEM devices were observed. Analysis should be performed on the same ROTEM device if small differences are of importance for treatment.

Cited by 125 publications

References 24 publications

Thrombelastography Maximal Clot Strength Could Predict One-Year Functional Outcome in Patients with Ischemic Stroke

Thrombelastography Maximal Clot Strength Could Predict One-Year Functional Outcome in Patients with Ischemic Stroke

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

Point of Care and Factor Concentrate-Based Coagulation Algorithms

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