TEG and ROTEM: Technology and clinical applications

Whiting, David; DiNardo, James A.

doi:10.1002/ajh.23599

Cited by 517 publications

(516 citation statements)

References 35 publications

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“…Results may be generated within 5 minutes when using rapid TEG, in which tissue factor is used to expedite clotting. 65 Evidence also supports the cost-effectiveness of VHAs compared with CCTs. 66 Device-specific limitations may influence the preference of one VHA platform over the other.…”

mentioning

confidence: 85%

Neurosurgical applications of viscoelastic hemostatic assays

Kvint¹,

Schuster²,

Kumar

2017

Neurosurgical Focus

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Patients taking antithrombotic agents are very common in neurosurgical practice. The perioperative management of these patients can be extremely challenging especially as newer agents, with poorly defined laboratory monitoring and reversal strategies, become more prevalent. This is especially true with emergent cases in which rapid reversal of anticoagulation is required and the patient’s exact medical history is not available. With an aging patient population and the associated increase in diseases such as atrial fibrillation, it is expected that the use of these agents will continue to rise in coming years. Furthermore, thromboembolic complications such as deep venous thrombosis, pulmonary embolism, and myocardial infarction are common complications of major surgery. These trends, in conjunction with a growing understanding of the hemostatic process and its contribution to the pathophysiology of disease, stress the importance of the complete evaluation of a patient’s hemostatic profile in guiding management decisions. Viscoelastic hemostatic assays (VHAs), such as thromboelastography and rotational thromboelastometry, are global assessments of coagulation that account for the cellular and plasma components of coagulation. This FDA-approved technology has been available for decades and has been widely used in cardiac surgery and liver transplantation. Although VHAs were cumbersome in the past, advances in software and design have made them more accurate, reliable, and accessible to the neurosurgeon. VHAs have demonstrated utility in guiding intraoperative blood product transfusion, identifying coagulopathy in trauma, and managing postoperative thromboprophylaxis. The first half of this review aims to evaluate and assess VHAs, while the latter half seeks to appraise the evidence supporting their use in neurosurgical populations.

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mentioning

confidence: 85%

Neurosurgical applications of viscoelastic hemostatic assays

Kvint¹,

Schuster²,

Kumar

2017

Neurosurgical Focus

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“…The kinetic change is detected optically by an integrated computer (TEMogram). Using several cuvettes at a time with different reagents, it is able to measure the interactions of coagulation factors, inhibitors and cellular components during the phases of clotting and subsequent lysis over time [30,[32][33][34]. Compared to the ROTEM, Kinexus Pro provided also information on the coagulation process over time in dependence of the chosen coagulation assay and of various inhibitor concentrations.…”

Section: Discussionmentioning

confidence: 99%

“…It is a medical device that is currently used in clinical practice [29][30][31]. The ROTEM uses a fixed cuvette (Cup) with a cylindrical pin that is immersed into the cup filled with whole blood (gap of 1 mm).…”

Section: Discussionmentioning

confidence: 99%

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Dynamic and Quantitative Assessment of Blood Coagulation Status with an Oscillatory Rheometer

et al. 2018

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During open heart surgery, the haemostasis status of a patient has to be monitored permanently in order to quickly and reliably detect bleeding or coagulation-based disorders. Currently, no single medical device is available to provide a comprehensive solution for monitoring the coagulation status (coagulation, platelets and fibrinolysis). We intend to approach this problem with a rheological method. Here, we compared the performance of an oscillatory rheometer with a medical reference device, a ball coagulometer. Measuring the extrinsic coagulation (prothrombin time; PT), various heparin concentrations (0.5-2.0 IU/mL) could be differentiated and also discriminated from the intrinsic coagulation (activated partial thromboplastin time; aPTT) providing comparable clotting times between rheometer and ball coagulometer. In addition, the oscillatory rheometer was capable to detect the antagonising of heparin with the equimolar concentration of protamine and also the titration of various protamine concentrations (0.5-3.0 IU/mL) to a fixed heparin concentration (2 IU/mL). The addition of increasing concentrations of heparin to citrated blood prolonged the clotting time (CT), changed the slope calculated by linear regression of the elastic and viscous shear moduli (i.e., information of the coagulation process) and changed the value of the shear moduli at the end of the measurement (300 s). These results indicate that the oscillatory rheometer is capable to dynamically measure the haemostasis status with different activators and various inhibitor concentrations.

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“…Their main uses are the monitoring of vitamin-K antagonist oral anticoagulants, the assessment of platelet function, in particular in patients undergoing anti-platelets therapy, as well as the rapid evaluation of clotting function in bleeding patients during surgery and in emergency settings [33][34][35][36][37]. Out of these the viscoelastometric POCT devices are particularly useful in giving quick information on all the main phases and components of clot formation, including fibrinogen concentration, platelet activity and fibrinolysis [38]. For this reason they are utilized to guide the clinical management of acute coagulopathy that follows trauma and hemorrhages, including obstetric cases [39][40][41].…”

Section: Hemostasismentioning

confidence: 99%

Point of Care Testing and Transfusion Safety in Resource Limited Settings: A Review

Musi¹

2015

J Blood Disord Transfus

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Worldwide, one of the fastest growing aspects of clinical laboratory testing is point of care testing (POCT). Decentralized patient care and access to testing in under-served areas are key elements in the evolving expansion of POCT. Several available POCT devices can potentially contribute to safer transfusion practices in resourcelimited settings. Only "rapid diagnostic tests" and some simple hemoglobinometers are normally encountered in the peripheral hospitals of low income countries. Strengths, weaknesses and barriers of large scale utilization of POCT in transfusion medicine are discussed.

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TEG and ROTEM: Technology and clinical applications

Cited by 517 publications

References 35 publications

Neurosurgical applications of viscoelastic hemostatic assays

Neurosurgical applications of viscoelastic hemostatic assays

Dynamic and Quantitative Assessment of Blood Coagulation Status with an Oscillatory Rheometer

Point of Care Testing and Transfusion Safety in Resource Limited Settings: A Review

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