TEG and ROTEM: Technology and clinical applications
David Whiting,James A. DiNardo +1 more
TLDR
Rotational thromboelastometry (ROTEM) and TEG analysis is being incorporated in vertical algorithms to diagnose and treat bleeding in high‐risk populations such as those undergoing cardiac surgery or suffering from blunt trauma.Abstract:
Initially described in 1948 by Hertert thromboelastography (TEG) provides a real-time assessment of viscoelastic clot strength in whole blood. Rotational thromboelastometry (ROTEM) evolved from TEG technology and both devices generate output by transducing changes in the viscoelastic strength of a small sample of clotting blood (300 µl) to which a constant rotational force is applied. These point of care devices allow visual assessment of blood coagulation from clot formation, through propagation, and stabilization, until clot dissolution. Computer analysis of the output allows sophisticated clot formation/dissolution kinetics and clot strength data to be generated. Activation of clot formation can be initiated with both intrinsic (kaolin, ellagic acid) and extrinsic (tissue factor) activators. In addition, the independent contributions of platelets and fibrinogen to final clot strength can be assessed using added platelet inhibitors (abciximab and cytochalasin D). Increasingly, ROTEM and TEG analysis is being incorporated in vertical algorithms to diagnose and treat bleeding in high-risk populations such as those undergoing cardiac surgery or suffering from blunt trauma. Some evidence suggests these algorithms might reduce transfusions, but further study is needed to assess patient outcomes.read more
Citations
More filters
Journal ArticleDOI
Extracorporeal Membrane Oxygenation—Hemostatic Complications
Deirdre Murphy,Deirdre Murphy,Lisen Emma Hockings,Lisen Emma Hockings,Robert K. Andrews,Cecile Aubron,Elizabeth E. Gardiner,Vincent Pellegrino,Vincent Pellegrino,Amanda K. Davis +9 more
TL;DR: The mechanisms and management of hemostatic, thrombotic and hemolytic complications during ECMO support are described, which remain a leading cause of morbidity and mortality in patients on ECMO.
Journal ArticleDOI
Point-of-Care Hemostatic Testing in Cardiac Surgery: A Stepped-Wedge Clustered Randomized Controlled Trial.
Keyvan Karkouti,Jeannie Callum,Duminda N. Wijeysundera,Vivek Rao,Mark Crowther,Hilary P. Grocott,Ruxandra Pinto,Damon C. Scales,Tacs Investigators +8 more
TL;DR: Implementation of point-of-care hemostatic testing within the context of an integrated transfusion algorithm reduces red blood cell transfusion, platelet transfusions, and major bleeding following cardiac surgery, and these findings support the broader adoption of point of care he mostatic testing into clinical practice.
Journal ArticleDOI
Hypofibrinolytic state and high thrombin generation may play a major role in SARS-COV2 associated thrombosis.
Christophe Nougier,Remi Benoit,Marie Simon,Helene Desmurs-Clavel,Guillaume Marcotte,Laurent Argaud,Jean Stephane David,Aurelie Bonnet,Claude Negrier,Yesim Dargaud +9 more
TL;DR: Bed rest, obesity, hypoxia, coagulopathy, and acute excessive inflammation are potential mechanisms reported by previous studies and are crucial for developing more appropriate prophylaxis and treatment strategies.
Journal ArticleDOI
Coagulopathy and haemorrhagic progression in traumatic brain injury: advances in mechanisms, diagnosis, and management
Marc Maegele,Herbert Schöchl,Tomas Menovsky,Hugues Maréchal,Niklas Marklund,Andras Buki,Simon J. Stanworth +6 more
TL;DR: The main challenge for management is to address therisk of hypocoagulopathy with prolonged bleeding and progression of haemorrhagic lesions, and the risk of hypercoagulopathic with an increased prothrombotic tendency also warrants consideration.
Journal ArticleDOI
Clinical Utility of Viscoelastic Tests of Coagulation (TEG/ROTEM) in Patients with Liver Disease and during Liver Transplantation.
TL;DR: Despite prolonged PT/INR and low platelet counts, viscoelastic tests are within normal range in many patients with both acute and chronic liver disease, commensurate with the concept of rebalanced hemostasis, and in keeping with the fact that an increasing number of patients undergo liver transplantation without the need for blood or blood products.
References
More filters
Journal ArticleDOI
The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial.
Ian Roberts,Haleema Shakur,AO Afolabi,Karim Brohi,Timothy J Coats,Yashbir Dewan,Satoshi Gando,Gordon H. Guyatt,Beverley J. Hunt,Carlos Morales,Pablo Perel,David Prieto-Merino,Tom Woolley +12 more
TL;DR: Strong evidence is recorded that tranexamic acid should be given as early as possible to bleeding trauma patients with significant haemorrhage, and for trauma patients admitted late after injury, tranExamic acid is less effective and could be harmful.
Journal ArticleDOI
Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery.
Linda Shore-Lesserson,HE Manspeizer,Marietta DePerio,S Francis,Frances Vela-Cantos,M A Ergin +5 more
TL;DR: Point-of-care coagulation monitoring using TEG resulted in fewer transfusions in the postoperative period, and this data support the use of TEG in an algorithm to guide transfusion therapy in complex cardiac surgery.
Journal ArticleDOI
Intraoperative Changes in Blood Coagulation and Thrombelastographic Monitoring in Liver Transplantation
Y. Kang,Douglas J. Martin,Jose Marquez,Jessica H. Lewis,Franklin A. Bontempo,Byers W. Shaw,Thomas E. Starzl,Peter M. Winter +7 more
TL;DR: Thrombelastography was shown to be a reliable and rapid monitoring system and its use was associated with a 33% reduction of blood and fluid infusion volume, whereas blood coagulability was maintained without an increase in the number of blood product donors.
Journal ArticleDOI
Blood clotting studies with Thrombus stressography; a new Investigation procedure.
TL;DR: In this article, a new Methode zur adaquaten Untersuchung der Blutgerinnungsvorgange an unverandertem Vollblut beschrieben, welche erstmalig die fortlaufende Bestimmung der Fibrinelastizitat zur Grundlage hat.
Journal ArticleDOI
Point-of-care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients.
Christian F Weber,Klaus Görlinger,Dirk Meininger,Eva Herrmann,Tobias M. Bingold,Anton Moritz,Lawrence H. Cohn,Kai Zacharowski +7 more
TL;DR: Hemostatic therapy based on POC testing reduced patient exposure to allogenic blood products and provided significant benefits with respect to clinical outcomes.
Related Papers (5)
Coagulation monitoring: current techniques and clinical use of viscoelastic point-of-care coagulation devices
Michael T. Ganter,C. K. Hofer +1 more
Goal-directed Hemostatic Resuscitation of Trauma-induced Coagulopathy: A Pragmatic Randomized Clinical Trial Comparing a Viscoelastic Assay to Conventional Coagulation Assays.
Eduardo Gonzalez,Ernest E. Moore,Hunter B. Moore,Michael P. Chapman,Theresa L. Chin,Arsen Ghasabyan,Max V. Wohlauer,Carlton C. Barnett,Denis D. Bensard,Walter L. Biffl,Clay Cothren Burlew,Jeffrey L. Johnson,Fredric M. Pieracci,Gregory J. Jurkovich,Anirban Banerjee,Christopher C. Silliman,Angela Sauaia,Angela Sauaia,Angela Sauaia +18 more