The utility of viscoelastic methods in the prevention and treatment of bleeding and hospital‐associated venous thromboembolism in perioperative care: guidance from the SSC of the ISTH

Thomas, William; Samama, Charles Marc; Greinacher, Andreas; Hunt, Beverley J.

doi:10.1111/jth.14265

Cited by 27 publications

(32 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Low fibrinogen and low platelet counts are associated with clinically significant bleeding and often require therapeutic intervention with allogenic blood products or factor concentrates. Perioperative and trauma guidelines recommend specific fibrinogen and platelet threshold values that should be targeted for interventions [4][5][6][7][8][9][10]. The Practice Guidelines for Perioperative Blood Management issued by the American Society of Anesthesiologists (ASA) recommend the utilization of platelet transfusion if the platelet count is less than 50,000/μl in the presence of bleeding [4].…”

Section: Discussionmentioning

confidence: 99%

“…Clinical practice guidelines for the management of coagulopathic bleeding in the perioperative and critical care settings recommend goaldirected therapy to restore balanced hemostasis [4][5][6][7][8][9][10]. Hypofibrinogenemia (fibrinogen values below 150 mg/dl) and thrombocytopenia (platelet count between 50,000/μl and 75,000/μl, or less) are associated with worsening coagulopathy and critical bleeding in cardiac and other major surgery, which warrants an immediate intervention.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prediction of hypofibrinogenemia and thrombocytopenia at the point of care with the Quantra® QPlus® System

Naik

Tanaka

Sudhagoni

et al. 2021

Thrombosis Research

View full text Add to dashboard Cite

Low fibrinogen and platelet counts are associated with bleeding and the need for transfusion. In this study, we investigated whether the Quantra® QPlus® parameters Fibrinogen Contribution (FCS) and Platelet Contribution (PCS) to clot stiffness could predict commonly used fibrinogen and platelet transfusion thresholds in patients undergoing major surgical procedures. Methods: This study used data from a multicenter, prospective observational study of adult patients undergoing cardiac or major orthopedic surgery. Quantra and laboratory assays were performed in parallel at multiple time points. Logistic regression models were used to assess the ability of FCS and PCS to predict fibrinogen and platelet thresholds used to guide transfusions. Receiver operating characteristics (ROC) curves were analyzed to determine the diagnostic accuracy and the optimal FCS and PCS values corresponding to the laboratory-based thresholds. Results: The areas under the ROC curves (AUCs) for FCS at fibrinogen thresholds of <120, 150, and 200 mg/dl ranged from 0.96 to 0.89. Similarly, for PCS at platelet thresholds of <50, 80, 100,000/μl, AUCs ranged from 0.95 to 0.89. The proposed optimal FCS and PCS cutoff values showed high negative predictive value and high sensitivity and specificity (both >86%) at the lowest fibrinogen and platelet threshold levels. Conclusions: This study identifies potential cutoff values for QPlus FCS and PCS proposed for use in place of or in conjunction with laboratory-based assays fibrinogen and platelet thresholds to guide transfusion decisions in surgical patients. These cutoff values will need to be validated in future studies.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prediction of hypofibrinogenemia and thrombocytopenia at the point of care with the Quantra® QPlus® System

Naik

Tanaka

Sudhagoni

et al. 2021

Thrombosis Research

View full text Add to dashboard Cite

show abstract

“…Second, the direct signs of hypercoagulability observed in this cohort rest mainly on the TEG parameters. This device is used to guide transfusion in critically ill hemorrhagic patients [12] and more rarely to detect hypercoagulability, although there are observations showing that TEG is also useful to detect hypercoagulability [13][14][15]. These limitations notwithstanding, it is of interest to note that a state of hypercoagulability has been shown in these patients.…”

Section: Accepted Articlementioning

confidence: 99%

Hypercoagulability of COVID‐19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis

Panigada

Bottino

Tagliabue

et al. 2020

Journal of Thrombosis and Haemostasis

1,223

1,274

View full text Add to dashboard Cite

Background:The severe inflammatory state secondary to COVID-19 leads to a severe derangement of hemostasis that has been recently described as a state of disseminated intravascular coagulation (DIC) and consumption coagulopathy, defined as decreased platelet count, increased fibrin(ogen) degradation products such as D-dimer, as well as low fibrinogen.Aims: Whole blood from 24 patients admitted at the intensive care unit because of COVID-19 was collected and evaluated with thromboelastography by the TEG pointof-care device on a single occasion and six underwent repeated measurements on two consecutive days for a total of 30 observations. Plasma was evaluated for the other parameters of hemostasis.Results: TEG parameters are consistent with a state of hypercoagulability as shown by decreased values, and increased values of K angle and MA. Platelet count was normal or increased, prothrombin time and activated partial thromboplastin time were near(normal).Fibrinogen was increased and D-dimer was dramatically increased. C-reactive protein was increased. Factor VIII and von Willebrand factor (n = 11) were increased. Antithrombin (n = 11) was marginally decreased and protein C (n = 11) was increased. Conclusion:The results of this cohort of patients with COVID-19 are not consistent with acute DIC, rather they support hypercoagulability together with a severe inflammatory state. These findings may explain the events of venous thromboembolism observed in some of these patients and support antithrombotic prophylaxis/ treatment. Clinical trials are urgently needed to establish the type of drug, dosage, and optimal duration of prophylaxis.

show abstract

“…The use of VET in this population is appealing and allows for a more physiologic representation of coagulation and fibrinolysis. Viscoelastic tests are now used frequently in liver transplantation and show promise in assisting with surgical and procedure‐based hemostasis management . Here the authors demonstrate no significant difference in transfusion or associated costs between the conventional and ROTEM‐guided strategies.…”

mentioning

confidence: 70%

Commentary on: Comparison of three transfusion protocols prior to central venous catheterization in patients with cirrhosis: A randomized controlled trial

Intagliata

Villa

2020

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

The utility of viscoelastic methods in the prevention and treatment of bleeding and hospital‐associated venous thromboembolism in perioperative care: guidance from the SSC of the ISTH

Cited by 27 publications

References 31 publications

Prediction of hypofibrinogenemia and thrombocytopenia at the point of care with the Quantra® QPlus® System

Prediction of hypofibrinogenemia and thrombocytopenia at the point of care with the Quantra® QPlus® System

Hypercoagulability of COVID‐19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis

Commentary on: Comparison of three transfusion protocols prior to central venous catheterization in patients with cirrhosis: A randomized controlled trial

Contact Info

Product

Resources

About