Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices

Volod, Oksana; Bunch, Connor M.; Zackariya, Nuha; Moore, Ernest E.; Moore, Hunter B.; Kwaan, Hau C.; Neal, Matthew D.; Al-Fadhl, Mahmoud D.; Patel, Shivani; Wiarda, Grant; Al-Fadhl, Hamid; McCoy, Max L; Thomas, Anthony V.; Thomas, Scott; Gillespie, Laura; Khan, Rashid Z; Zamlut, Mahmud; Kamphues, Peter; Fries, Dietmar; Walsh, Mark

doi:10.3390/jcm11030860

Cited by 53 publications

(71 citation statements)

References 174 publications

(283 reference statements)

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“…Viscoelastic point-of-care tests, on the other hand, such as rotational thromboelastometry (ROTEM), provide the results as quickly as minutes upon blood collection. That is why in a situation of a patient’s rapidly deteriorating clinical state requiring fast and decisive proceedings, viscoelastic point-of-care testing such as ROTEM allows for a safer, more accurate, personalized, goal-directed bleeding management aimed at replenishing precisely what the patient lacks [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

In Vivo Effects of Balanced Crystalloid or Gelatine Infusions on Functional Parameters of Coagulation and Fibrinolysis: A Prospective Randomized Crossover Study

Wiórek

Mazur

Żurawska

et al. 2022

JPM

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Prudent administration of fluids helps restore or maintain hemodynamic stability in the setting of perioperative blood loss. However, fluids may arguably exacerbate the existing coagulopathy. We sought to investigate the influence of balanced crystalloid and synthetic gelatine infusions on coagulation and fibrinolysis in healthy volunteers. This prospective randomized crossover study included 25 males aged 18–30 years. Infusions performed included 20 mL/kg of a balanced crystalloid solution (Optilyte®) or 20 mL/kg of gelatine 26.500 Da (Geloplasma®) in a random order over a period of 2 weeks. Laboratory analysis included conventional coagulation parameters and rotational thromboelastometry (ROTEM) assays. We confirmed a decrease in fibrinogen concentration and the number of platelets, and prolongation of PT after infusions. Compared to baseline values, differences in the ROTEM assays’ results after infusions signified the decrease in coagulation factors and fibrinogen concentration, causing impaired fibrin polymerization and clot structure. The ROTEM indicator of clot lysis remained unaffected. In the case of both Optilyte® and Geloplasma®, the results suggested relevant dilution. Gelatine disrupted the process of clot formation more than balanced crystalloid. Infusions of both crystalloid and saline-free colloid solutions causing up to 30% blood dilution cause significant dilution of the coagulation factors, platelets, and fibrinogen. However, balanced crystalloid infusion provides less infusion-induced coagulopathy compared to gelatine.

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Section: Discussionmentioning

confidence: 99%

In Vivo Effects of Balanced Crystalloid or Gelatine Infusions on Functional Parameters of Coagulation and Fibrinolysis: A Prospective Randomized Crossover Study

Wiórek

Mazur

Żurawska

et al. 2022

JPM

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“…Rotational thromboelastometry (ROTEM) and thromboelastography (TEG) are two laboratory methods that assess hemostasis by evaluating the viscoelastic properties of whole blood specimens [ 11 ]. Conventional laboratory coagulation tests such as prothrombin time (PT), the International Normalized Ratio (INR), and activated partial thromboplastin time (aPTT) are plasma-based assays that can evaluate only a specific phase of coagulation.…”

Section: Introductionmentioning

confidence: 99%

The Hypercoagulable Profile of Patients with Bone Tumors: A Pilot Observational Study Using Rotational Thromboelastometry

Tsantes

Loukopoulou

Papadopoulos

et al. 2022

Cancers

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Introduction: A detailed evaluation of the malignancy-associated coagulopathy (MAC) in surgical patients with bone tumors may allow for more effective thromboprophylactic measures. The purpose of this study was to assess the perioperative hemostatic changes in patients with bone tumors, using rotational thromboelastometry (ROTEM). Methods: An observational study was performed, including 50 patients with bone tumors who underwent oncologic resection and 30 healthy controls, matched for age and gender. The preoperative and postoperative laboratory evaluation of coagulation in both groups included conventional coagulation tests and a ROTEM analysis. The results of the conventional coagulation tests and the ROTEM analysis were compared between the two groups. Results: The results of the conventional coagulation tests were comparable between the tumor patients and the healthy controls. However, compared to the healthy adults, the tumor patients had lower CT (p < 0.001) and CFT (p < 0.001) values suggesting a rapid induction of the coagulation cascade, elevated A10 (p < 0.001) and MCF (p < 0.001) values indicating a higher clot strength and platelet activation, and elevated LI60 (p < 0.001) values indicating hypofibrinolysis in patients with bone tumors. The multiple linear regression analysis (controlling for potential confounding factors) confirmed the independent association of bone tumors with these hemostatic changes. Conclusions: Our results support the advantageous use of a ROTEM in patients with bone tumors over conventional coagulation tests because the qualitative changes in the hemostatic profile of these patients that can be detected by a ROTEM analysis cannot be identified by conventional tests. The ROTEM results indicate that the hypercoagulable state in patients with bone tumors is caused by the malignancy-associated activation of the coagulation cascade, platelet activation, and hypofibrinolysis.

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“…TEG and ROTEM have different terminologies, use different activators, and rely on both specific parameter values and the overall pattern recognition for interpretation. This reliance on assay familiarity and pattern recognition for bedside interpretation may be a barrier to a more common utilization of VHAs in orthopedics [ 30 , 39 , 44 , 45 ].…”

Section: Introductionmentioning

confidence: 99%

“…Both assays generate parameters describing the clot amplitude at 5 min intervals after R/CT until the graph reaches MA/MCF. These parameters are A5, A10, etc., in rTEG and CA5, CA10, etc., in EXTEM [ 44 ]. These values, in addition to the five key parameters described above, allow the real-time assessment of clotting abnormalities, allowing for an early analysis of hemostatic competence and anticipation of necessary blood product therapy ( Table 1 ) [ 40 , 45 , 47 , 48 ].…”

Section: Introductionmentioning

confidence: 99%

Viscoelastic Hemostatic Assays for Orthopedic Trauma and Elective Procedures

Mamczak

Speybroeck

Stillson

et al. 2022

JCM

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The application of viscoelastic hemostatic assays (VHAs) (e.g., thromboelastography (TEG) and rotational thromboelastometry (ROTEM)) in orthopedics is in its relative infancy when compared with other surgical fields. Fortunately, several recent studies describe the emerging use of VHAs to quickly and reliably analyze the real-time coagulation and fibrinolytic status in both orthopedic trauma and elective orthopedic surgery. Trauma-induced coagulopathy—a spectrum of abnormal coagulation phenotypes including clotting factor depletion, inadequate thrombin generation, platelet dysfunction, and dysregulated fibrinolysis—remains a potentially fatal complication in severely injured and/or hemorrhaging patients whose timely diagnosis and management are aided by the use of VHAs. Furthermore, VHAs are an invaluable compliment to common coagulation tests by facilitating the detection of hypercoagulable states commonly associated with orthopedic injury and postoperative status. The use of VHAs to identify hypercoagulability allows for an accurate venous thromboembolism (VTE) risk assessment and monitoring of VTE prophylaxis. Until now, the data have been insufficient to permit an individualized approach with regard to dosing and duration for VTE thromboprophylaxis. By incorporating VHAs into routine practice, orthopedic surgeons will be better equipped to diagnose and treat the complete spectrum of coagulation abnormalities faced by orthopedic patients. This work serves as an educational primer and up-to-date review of the current literature on the use of VHAs in orthopedic surgery.

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Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices

Cited by 53 publications

References 174 publications

In Vivo Effects of Balanced Crystalloid or Gelatine Infusions on Functional Parameters of Coagulation and Fibrinolysis: A Prospective Randomized Crossover Study

In Vivo Effects of Balanced Crystalloid or Gelatine Infusions on Functional Parameters of Coagulation and Fibrinolysis: A Prospective Randomized Crossover Study

The Hypercoagulable Profile of Patients with Bone Tumors: A Pilot Observational Study Using Rotational Thromboelastometry

Viscoelastic Hemostatic Assays for Orthopedic Trauma and Elective Procedures

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