Whole Blood Assay: Thromboelastometry – Basics

Görlinger, Klaus; Iqbal, James; Dirkmann, Daniel; Tanaka, Kenichi A.

doi:10.1007/978-3-030-56338-7_6

Cited by 3 publications

(5 citation statements)

References 227 publications

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“…Calculated thrombosis indices: shear elastic modulus strength (G = 5000 × MCF / (100 -MCF)) and the thrombodynamic potential index (TPI = [(100 × MCF) / (100 -MCF)] / CFT in s −1 ) [32].…”

Section: Thromboelastometry (Rotem) Assays and Parametermentioning

confidence: 99%

Haemostasis patterns in patients with acute-on-chronic liver failure and acute decompensation of cirrhosis including thromboelastometric tests with and without the addition of Protac: a pilot study

et al. 2022

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Background Thromboelastometry is considered the best method to assesses hemostasis in liver disease. Diagnostic performance could be improved by adding protein C activators such as thrombomodulin or Protac®. We assessed changes in ROTEM parameters after the addition of Protac® in patients with acute-on-chronic liver failure (ACLF), acute decompensation (AD), and healthy individuals (HI) to define different hemostasis patterns, considering standard and velocity ROTEM parameters, and assess whether Protac® can improve the definition of the pattern. Methods Pre-test, we investigated whether diluted EXTEM reagent improved the effect of Protac® on the clotting time (CT)-ratio with and without Protac®. Ten ACLF and 20 AD patients and 21 HI were included in the main study. Results Standard EXTEM was used in the main study. INTEM CFT, INTEM A5 (inverse), and INTEM TPI (inverse) were the parameters that best differentiated liver disease from HI (ROC AUC, 0.921, 0.906, and 0.928, respectively; all P-values < 0.001). Combining INTEM CFT with EXTEM LI60-ratio only slightly improved the diagnostic performance (ROC AUC, 0.948; P < 0.001). EXTEM LI60 and INTEM maxV-t were the parameters that best differentiated between ACLF and AD patients (ROC AUC, 0.743, P = 0.033; and 0.723, P = 0.050; respectively). Combining EXTEM LI60 + INTEM maxV-t moderately improved the diagnostic performance (ROC AUC, 0.81, P < 0.001). Conclusions ROTEM velocity, fibrinolysis parameters and the indices calculated improve the diagnosis in combination with standard parameters (e.g., CFT and A5). Ratios calculated with and without Protac® (e.g., EXTEM LI60-ratio) only slightly increased the diagnostic performance in discriminating hemostasis patterns.

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Section: Thromboelastometry (Rotem) Assays and Parametermentioning

confidence: 99%

Haemostasis patterns in patients with acute-on-chronic liver failure and acute decompensation of cirrhosis including thromboelastometric tests with and without the addition of Protac: a pilot study

et al. 2022

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“…This allows for fibrinogen-targeted, dose-dependent therapy guided by TEG functional fibrinogen or FIBTEM amplitude. 9,11,15,[191][192][193][194][195][196][197][198] Higher FIBTEM amplitudes are believed to partially compensate for thrombocytopenia. 199 Additionally, analysis of Quantra sonorheometry clot stiffness parameters correlates strongly with FIBTEM and EXTEM and allows for accurate assessments to be made regarding coagulopathy management in the CPB setting.…”

Section: Cardiac Surgerymentioning

confidence: 99%

“…They are also more complicated than CCTs, meaning users must become familiarized with the instruments and require greater hands-on experience for consistently accurate and precise results. 15 23 24 39 44 45 46 Another drawback that affects widespread adoption of VETs is the time delay involved in the transport of blood samples from the trauma bay or operating room to a remote central laboratory for processing. However, whether the assay is performed at the site of resuscitation or at a central laboratory, robust technology allows for real time remote viewing, which provides an invaluable advantage over CCTs.…”

Section: Conventional Coagulation Tests Versus Viscoelastic Tests: Ba...mentioning

confidence: 99%

“…This is unlike the classical linear process of the plasma-based PT/PTT assays. 7 8 9 10 11 12 13 14 15 16…”

mentioning

confidence: 99%

“…This is unlike the classical linear process of the plasma-based PT/PTT assays. [7][8][9][10][11][12][13][14][15][16] Accurate estimation of hemostatic competence of the clotting or bleeding patient has therefore evolved from plasmabased tests-originally designed to evaluate patients with congenital or acquired clotting factor deficiencies (e.g., hemophilias) and guide anticoagulant therapy-to cell-based VETs. In the last decade, there has been a rapid expansion of the adoption of VETs such that now there is ambivalence regarding the relative importance of CCTs and VETs in various clinical scenarios.…”

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The Choice between Plasma-Based Common Coagulation Tests and Cell-Based Viscoelastic Tests in Monitoring Hemostatic Competence: Not an either–or Proposition

Bunch

Berquist

Ansari

et al. 2022

Semin Thromb Hemost

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There has been a significant interest in the last decade in the use of viscoelastic tests (VETs) to determine the hemostatic competence of bleeding patients. Previously, common coagulation tests (CCTs) such as the prothrombin time (PT) and partial thromboplastin time (PTT) were used to assist in the guidance of blood component and hemostatic adjunctive therapy for these patients. However, the experience of decades of VET use in liver failure with transplantation, cardiac surgery, and trauma has now spread to obstetrical hemorrhage and congenital and acquired coagulopathies. Since CCTs measure only 5 to 10% of the lifespan of a clot, these assays have been found to be of limited use for acute surgical and medical conditions, whereby rapid results are required. However, there are medical indications for the PT/PTT that cannot be supplanted by VETs. Therefore, the choice of whether to use a CCT or a VET to guide blood component therapy or hemostatic adjunctive therapy may often require consideration of both methodologies. In this review, we provide examples of the relative indications for CCTs and VETs in monitoring hemostatic competence of bleeding patients.

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Evaluation of health outcomes after the implementation of rotational thromboelastometry in patients undergoing cardiac surgery

Rodríguez-Martín

Sánchez-Mora

Fernández-López

et al. 2022

Scandinavian Journal of Clinical and Laboratory Investigation

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Whole Blood Assay: Thromboelastometry – Basics

Cited by 3 publications

References 227 publications

Haemostasis patterns in patients with acute-on-chronic liver failure and acute decompensation of cirrhosis including thromboelastometric tests with and without the addition of Protac: a pilot study

Haemostasis patterns in patients with acute-on-chronic liver failure and acute decompensation of cirrhosis including thromboelastometric tests with and without the addition of Protac: a pilot study

The Choice between Plasma-Based Common Coagulation Tests and Cell-Based Viscoelastic Tests in Monitoring Hemostatic Competence: Not an either–or Proposition

Evaluation of health outcomes after the implementation of rotational thromboelastometry in patients undergoing cardiac surgery

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