Rotational thromboelastography for monitoring of fibrinogen concentrate therapy in fibrinogen deficiency

Kalina, Uwe; Stöhr, Hans Arnold; Bickhard, Heike; Knaub, Sigurd; Siboni, Simona Maria; Mannucci, Pier Mannuccio; Peyvandi, Flora

doi:10.1097/mbc.0b013e32830ef90c

Cited by 74 publications

(56 citation statements)

References 33 publications

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“…Rotational thrombelastography (ROTEM) yields information not only about the fibrin clot formation but also measures fibrin-platelet interaction, clot firmness and fibrinolysis and may provide a more comprehensive impression of the coagulation process under fibrinogen replacement [26].…”

Section: Discussionmentioning

confidence: 99%

Treatment of patients with dysfibrinogenemia and a history of abortions during pregnancy

Miesbach

Galanakis²,

Scharrer³

2009

Blood Coagulation &Amp; Fibrinolysis

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Dysfibrinogenemia is caused by a variety of structural abnormalities in the fibrinogen molecule, which results in a tendency for bleeding and thrombosis as well as obstetric complications. The obstetric complications of dysfibrinogenemia include first-trimester pregnancy loss, hemorrhage, placental abruption, and thrombosis. We conducted a retrospective study of four cases of dysfibrinogenemic patients from one family (fibrinogen Frankfurt III) with a history of recurrent pregnancy loss and who were treated with fibrinogen concentrates. One patient had three consecutive abortions in the 6th, 7th and 11th week of pregnancy. The underlying fibrinogen gene mutation was Aalpha R16C, two propositae being homophenotyic and two heterophenotypic. The median age was 30.5 years (28-39 years). The median level of fibrinogen (Clauss) was 29 mg/dl (range less than 10-51 mg/dl, normal: 150-450 mg/dl), the median level of fibrinogen according to Schulz was in the normal range at 180 mg/dl (range 180-300 mg/dl). The reptilase time was prolonged to 55 s (median, normal: -20 s). Fibrinogen was administered from the beginning of the pregnancy until delivery. In three out of four patients, abortions could be avoided by continuous administration of fibrinogen concentrates commencing as early as possible during the pregnancy in order to achieve fibrinogen plasma concentrations (Clauss) over 100 mg/dl. For the prophylaxis of thrombotic events, low-molecular heparin at a dosage of 40-60 IE/kg was administered postpartum for 14 days.

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Section: Discussionmentioning

confidence: 99%

Treatment of patients with dysfibrinogenemia and a history of abortions during pregnancy

Miesbach

Galanakis²,

Scharrer³

2009

Blood Coagulation &Amp; Fibrinolysis

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“…An advantage of thrombelastometry is that the method allows determination of the combined effects of thrombocytopenia and hypofibrinogenaemia. It is interesting, in this regard, that thrombelastometry was recently demonstrated to be the most reliable method of identifying patients with afibrinogenaemia, hypofibrinogenaemia, and dysfibrinogenaemia [10].…”

Section: Discussionmentioning

confidence: 99%

Monitoring of haemostasis in liver transplantation: comparison of laboratory based and point of care tests

Herbstreit¹,

Winter

Peters³

et al. 2009

Anaesthesia

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SummaryDuring orthotopic liver transplanatation haemostasis is often disturbed and coagulation monitoring is mandatory. We compared the results obtained by whole blood prothrombin time and activated partial thromboplastin time assays (Hemochron Ò ) and thrombelastometry (ROTEM Ò 05) with laboratory coagulation assays (prothrombin time, activated partial prothrombin time, fibrinogen, and platelet count) in samples obtained during orthotopic liver transplantations. Determination of prothrombin time and activated partial prothrombin time using the Hemochron device showed good correlation with laboratory coagulation assays (r = 0.912, p < 0.001, and r = 0.794, p < 0.001). Maximum clot firmness as determined by thrombelastometry correlated well with platelet count (r = 0.779, p < 0.001) and, to a lesser degree, with fibrinogen concentration (r = 0.590, p < 0.001). During orthotopic liver transplantation, prothrombin time and activated partial prothrombin time can be reliably determined by the Hemochron device, while thrombelastometry allows assessment of platelet count and fibrinogen concentration. Coagulation abnormalities during orthotopic liver transplanation are characterised by decreased coagulation factors, antifibrinolytic factors and endogeneous anticoagulant factors [1], all of which represent a major perioperative challenge as both bleeding episodes and thrombotic events can be precipitated [2,3]. Accordingly, monitoring of the coagulation system during liver transplantation is important.Besides standard laboratory methods, point of care assays are gaining increasing acceptance since their results are rapidly available [4][5][6][7][8]. However, only sparse information is available on the comparability of point of care coagulation assays with laboratory coagulation assays in this special setting.The purpose of this study was to compare the results obtained by two point of care assays (thrombelastometry and the Hemochron Ò device) with those of conventional laboratory assays during orthotopic liver transplantation. MethodsCoagulation values obtained during 20 consecutive orthotopic liver transplantations were analysed after approval by the Local Research Ethics Committee and written informed consent of the patients.

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“…In a previous study, Kalina et al [32] demonstrated that the assessment of MCF by FIBTEM and EXTEM provided a consistent and more predictable response to fibrinogen administered in vitro to patients with afibrinogenemia, hypoFI or dys-FI, than the assessment of fibrinogen concentration by the von Clauss or ELISA method. In particular, while patients with dysFI demonstrated a good correlation between added fibrinogen and higher MCF readings, the response to fibrinogen spiking was found to be blunted by interactions with abnormal fibrinogen structure when using the von Clauss method.…”

Section: Patientsmentioning

confidence: 99%

Assessment of Selected ROTEM Parameters, Kinetics of Fibrinogen Polymerization and Plasmin Amidolytic Activity in Patients with Congenital Fibrinogen Defects

et al. 2016

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Rotational thromboelastography for monitoring of fibrinogen concentrate therapy in fibrinogen deficiency

Cited by 74 publications

References 33 publications

Treatment of patients with dysfibrinogenemia and a history of abortions during pregnancy

Treatment of patients with dysfibrinogenemia and a history of abortions during pregnancy

Monitoring of haemostasis in liver transplantation: comparison of laboratory based and point of care tests

Assessment of Selected ROTEM Parameters, Kinetics of Fibrinogen Polymerization and Plasmin Amidolytic Activity in Patients with Congenital Fibrinogen Defects

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