ROTEM reference ranges in a pregnant population from different nationalities/ethnic backgrounds

Gootjes, Dionne V.; Kuipers, Irma; Thomassen, Bregje J.W.; Verheul, Rolf J.; Vries, Saskia de; Mingelen, W.; Dunné, Frederique M. van; Ponjee, G. A. E.

doi:10.1111/ijlh.12996

Cited by 11 publications

(12 citation statements)

References 12 publications

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“…Similar to TEG, studies have also established ROTEM reference values that are consistent with pregnancy being a hypercoagulable state, with a positive correlation between increasing coagulability and increasing gestational age (Table S1b) 67‐70,70‐73 . Although Huissoud et al and Armstrong et al used similar sample sizes, Huissoud et al reported medians and interquartile ranges for ROTEM in all trimesters of pregnancy, whereas Armstrong et al established 95% reference ranges for the third trimester 67,68 .…”

Section: Use Of Teg/rotem In Obstetricsmentioning

confidence: 87%

“…Similar to TEG, studies have also established ROTEM reference values that are consistent with pregnancy being a hypercoagulable state, with a positive correlation between increasing coagulability and increasing gestational age (Table S1b). [67][68][69][70][70][71][72][73] Although Huissoud lower, whereas the MCF values were significantly higher in the pregnant group compared with the nonpregnant group. 67 Studies used ROTEM to show that hypercoagulation persists after delivery, up to the first 3 weeks postpartum.…”

Section: Rotem Reference Values For Healthy Pregnanciesmentioning

confidence: 99%

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Systematic review of viscoelastic testing (TEG/ROTEM) in obstetrics and recommendations from the women's SSC of the ISTH

Amgalan

Allen

Othman

et al. 2020

Journal of Thrombosis and Haemostasis

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Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are pointof-care viscoelastic devices that use whole blood samples to assess coagulation and fibrinolysis. These devices have been studied extensively in cardiac surgery, but there is limited robust evidence supporting its use in obstetrics. The hesitancy toward its routine use in obstetrics may be due to the current lack of randomized controlled trials and large observational studies. The study aims to systematically review studies that investigated TEG/ROTEM use in pregnancy or peripartum, and to provide recommendations for future studies to fill current research gaps. We performed a systematic review of studies on viscoelastic testing in obstetrics. Included studies were original research, used TEG or ROTEM during pregnancy or peripartum, and published in English. Ninety-three studies, spanning 31 years from 1989 to 2020 and with a total of 32,817 participants, were included. Sixty-two (66.7%) of the studies used TEG and 31 (33.3%) used ROTEM. To date, there are a total of two randomized controlled trials on TEG/ROTEM use in obstetrics. ROTEM may be used to guide transfusion therapy for postpartum hemorrhage. TEG and ROTEM can detect the hypercoagulable changes associated with pregnancy. Variability between study protocols and results suggests the need for future large prospective high-quality studies with standardized protocols to investigate the utility of TEG/ROTEM in assessing risk for thrombosis and hemorrhage as well as in guiding prophylaxis and treatment in obstetric patients. This review identifies the gaps and provides concrete recommendations for future studies to fill those gaps.

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Section: Use Of Teg/rotem In Obstetricsmentioning

confidence: 87%

“…Similar to TEG, studies have also established ROTEM reference values that are consistent with pregnancy being a hypercoagulable state, with a positive correlation between increasing coagulability and increasing gestational age (Table S1b). [67][68][69][70][70][71][72][73] Although Huissoud lower, whereas the MCF values were significantly higher in the pregnant group compared with the nonpregnant group. 67 Studies used ROTEM to show that hypercoagulation persists after delivery, up to the first 3 weeks postpartum.…”

Section: Rotem Reference Values For Healthy Pregnanciesmentioning

confidence: 99%

Systematic review of viscoelastic testing (TEG/ROTEM) in obstetrics and recommendations from the women's SSC of the ISTH

Amgalan

Allen

Othman

et al. 2020

Journal of Thrombosis and Haemostasis

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“…Recently, a prospective study showed for the first time that there are no significant differences in ROTEM reference ranges of pregnant women of different nationalities/ethnicities 24 …”

Section: Haematologic Management Of Massive Pph and How We Treat Itmentioning

confidence: 99%

Practical approach to transfusion management of post‐partum haemorrhage

Frigo

Agostini

Brizzi

et al. 2021

Transfusion Medicine

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Objectives To describe transfusion management during post‐partum haemorrhage (PPH) and the usefulness of standard or point‐of‐care (POC) laboratory tests for guiding haemostatic management. Background PPH is the leading cause of maternal mortality and severe maternal morbidity worldwide. Despite the efforts made in recent years, PPH is often burdened by preventable death. Recent data from the active Italian Obstetric Surveillance System (ItOSS) highlighted the following main critical issues: inadequate communication between healthcare professionals, inability to correctly and promptly assess the severity of haemorrhage, delays in diagnosis and treatment, failure to request blood promptly and inappropriate monitoring post‐partum. Materials and Methods Data in the literature have been compared with the rotational thromboelastometry (ROTEM)‐ and the thromboelastography (TEG)‐guided algorithms applied in the authors' departments. Results PPH transfusion therapy may have an empirical approach based on the standard use of blood products or a targeted approach based on coagulation monitoring by laboratory or POC tests. Here, the authors describe how they manage PPH in their departments, according to the Italian guidelines, along with the addition of a ROTEM‐ and a TEG‐guided algorithms developed by themselves. Conclusion Although the proposed algorithms have not been validated by trials or observational studies conducted in our departments, we believe that these indications could be useful for supporting clinical practice. Furthermore, we deem it appropriate to emphasise the importance of a multidisciplinary approach and the need for standardised and shared protocols to support the decisions of healthcare professionals.

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“…The use of TEG and ROTEM in the identification of hypocoagulopathy and guiding BCT/HAT in PPH is rising in popularity. Only recently have TEG and ROTEM been increasingly studied within the context of PPH [2,3,21,25,[52][53][54][55]58,59,[74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92]. BCT/HAT can be tailored to this patient population's specific needs using TEG or ROTEM parameters.…”

Section: The Use Of Vhas To Guide Bct and Hemostatic Adjunct Therapy In Pphmentioning

confidence: 99%

“…The main advantage of this pillar is that CCTs have wide availability and a high level of quality control and reproducibility [16,18]. However, laboratory tests with lengthy turnaround times may be limited in the context of rapid hemorrhage and will not reflect current hemostatic competence of the patient [8,11,[19][20][21][22][23]. It has been well documented that PT and aPTT have low sensitivities for determining the existence of hypocoagulopathy [19,24].…”

Section: Introductionmentioning

confidence: 99%

Viscoelastic Hemostatic Assays for Postpartum Hemorrhage

Liew-Spilger

Sorg

Brenner

et al. 2021

JCM

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This article discusses the importance and effectiveness of viscoelastic hemostatic assays (VHAs) in assessing hemostatic competence and guiding blood component therapy (BCT) in patients with postpartum hemorrhage (PPH). In recent years, VHAs such as thromboelastography and rotational thromboelastometry have increasingly been used to guide BCT, hemostatic adjunctive therapy and prohemostatic agents in PPH. The three pillars of identifying hemostatic competence include clinical observation, common coagulation tests, and VHAs. VHAs are advantageous because they assess the cumulative contribution of all components of the blood throughout the entire formation of a clot, have fast turnaround times, and are point-of-care tests that can be followed serially. Despite these advantages, VHAs are underused due to poor understanding of correct technique and result interpretation, a paucity of widespread standardization, and a lack of large clinical trials. These VHAs can also be used in cases of uterine atony, preeclampsia, acute fatty liver of pregnancy, amniotic fluid embolism, placental abruption, genital tract trauma, surgical trauma, and inherited and prepartum acquired coagulopathies. There exists an immediate need for a point-of-care test that can equip obstetricians with rapid results on developing coagulopathic states. The use of VHAs in predicting and treating PPH, although in an incipient state, can fulfill this need.

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ROTEM reference ranges in a pregnant population from different nationalities/ethnic backgrounds

Cited by 11 publications

References 12 publications

Systematic review of viscoelastic testing (TEG/ROTEM) in obstetrics and recommendations from the women's SSC of the ISTH

Systematic review of viscoelastic testing (TEG/ROTEM) in obstetrics and recommendations from the women's SSC of the ISTH

Practical approach to transfusion management of post‐partum haemorrhage

Viscoelastic Hemostatic Assays for Postpartum Hemorrhage

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