Thromboelastography (TEG) and thromboelastometry (ROTEM) for trauma-induced coagulopathy in adult trauma patients with bleeding

Hunt, Harriet; Hyde, Chris; Stanworth, Simon; Curry, Nicola; Perel, Pablo; Woolley, T.; Cooper, Chris; Ukoumunne, Obioha C

doi:10.1002/14651858.cd010438

Cited by 9 publications

(4 citation statements)

References 17 publications

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“…Also, a review in the Cochrane Library published in 2015 pointed out the presence of biases in the studies in trauma patients and the absence of a quality study in this field so far. 10…”

Section: S204mentioning

confidence: 99%

Point-of-care Testing of Coagulation in Intensive Care Unit: Role of Thromboelastography

Govil

Pal

2019

Indian Journal of Critical Care Medicine

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“…Also, a review in the Cochrane Library published in 2015 pointed out the presence of biases in the studies in trauma patients and the absence of a quality study in this field so far. 10…”

Section: S204mentioning

confidence: 99%

Point-of-care Testing of Coagulation in Intensive Care Unit: Role of Thromboelastography

Govil

Pal

2019

Indian Journal of Critical Care Medicine

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“…[109][110][111] A large body of literature has demonstrated the effectiveness of TEG® 5000 and ROTEM in guiding transfusion therapy, leading to a reduction in the need for and the volumes of blood and plasma transfusion. [109][110][111][112][113][114][115][116] Despite the popularity of viscoelastic-based POCTs, their usefulness has been questioned. A recent systematic review found insufficient evidence to support the diagnostic accuracy of thromboelastometry, and hence, was unable to offer advice on its use as a global measure of haemostatic function in trauma patients.…”

Section: Role Of Point Of Care Coagulation Testingmentioning

confidence: 99%

Management of bleeding in vascular surgery

Chee

Liu

Irwin

2016

British Journal of Anaesthesia

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Management of acute coagulopathy and blood loss during major vascular procedures poses a significant haemostatic challenge to anaesthetists. The acute coagulopathy is multifactorial in origin with tissue injury and hypotension as the precipitating factors, followed by dilution, hypothermia, acidemia, hyperfibrinolysis and systemic inflammatory response, all acting as a self-perpetuating spiral of events. The problem is confounded by the high prevalence of antithrombotic agent use in these patients and intraoperative heparin administration. Trials specifically examining bleeding management in vascular surgery are lacking, and much of the literature and guidelines are derived from studies on patients with trauma. In general, it is recommended to adopt permissive hypotension with a restrictive fluid strategy, using a combination of crystalloid and colloid solutions up to one litre during the initial resuscitation, after which blood products should be administered. A restrictive transfusion trigger for red cells remains the mainstay of treatment except for the high-risk patients, where the trigger should be individualized. Transfusion of blood components should be initiated by clinical evidence of coagulopathy such as diffuse microvascular bleeding, and then guided by either laboratory or point-of-care coagulation testing. Prophylactic antifibrinolytic use is recommended for all surgery where excessive bleeding is anticipated. Fibrinogen and prothrombin complex concentrates administration are recommended during massive transfusion, whereas rFVIIa should be reserved until all means have failed. While debates over the ideal resuscitative strategy continue, the approach to vascular haemostasis should be scientific, rational, and structured. As far as possible, therapy should be monitored and goal directed.

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“…Moreover, a recent Cochrane review revealed no clear survival benefit for the use of VETs in trauma [86] (Table 2).…”

Section: Disadvantages Of Goal-directed Coagulation Therapymentioning

confidence: 99%

Fixed ratio versus goal-directed therapy in trauma

Schöchl

Maegele

Voelckel

2016

Current Opinion in Anaesthesiology

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Thromboelastography (TEG) and thromboelastometry (ROTEM) for trauma-induced coagulopathy in adult trauma patients with bleeding

Cited by 9 publications

References 17 publications

Point-of-care Testing of Coagulation in Intensive Care Unit: Role of Thromboelastography

Point-of-care Testing of Coagulation in Intensive Care Unit: Role of Thromboelastography

Management of bleeding in vascular surgery

Fixed ratio versus goal-directed therapy in trauma

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