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ROTEM AND patient blood management

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https://www.readbyqxmd.com/read/27902939/factor-xiii-deficiency-enhances-thrombin-generation-due-to-impaired-fibrin-polymerization-an-effect-corrected-by-factor-xiii-replacement
#1
Hanna H Pitkänen, Annukka Jouppila, Marja Lemponen, Minna Ilmakunnas, Jouni Ahonen, Riitta Lassila
INTRODUCTION: Factor XIII (FXIII) cross-links fibrin, completing blood coagulation. Congenital FXIII deficiency is managed with plasma-derived FXIII (pdFXIII) or recombinant FXIII (rFXIII) concentrates. AIM: As the mechanisms protecting patients with low FXIII levels (<5IU/dL) from spontaneous bleeds remain unknown we assessed the interplay between thrombin generation (TG), fibrin formation and clot kinetics before and after FXIII administration in three patients with FXIII deficiency...
November 16, 2016: Thrombosis Research
https://www.readbyqxmd.com/read/27757554/thromboelastometry-guided-fibrinogen-replacement-therapy-in-cardiac-surgery-a-retrospective-observational-study
#2
Francesco Vasques, Luca Spiezia, Alberto Manfrini, Vincenzo Tarzia, Dario Fichera, Paolo Simioni, Gino Gerosa, Carlo Ori, Guido Di Gregorio
This retrospective, observational study compared the impact of a point-of-care rotational thromboelastometry (ROTEM(®)) method versus conventional bleeding management in terms of postoperative (24-h) blood loss, intraoperative and postoperative (24-h) transfusion requirement and length of stay in the postoperative intensive care unit (ICU) in patients undergoing cardiac surgery. Forty consecutive patients undergoing cardiac surgery under ROTEM(®)-guided hemostatic management were enrolled; the control population included 40 selected patients undergoing similar interventions without ROTEM(®) monitoring...
October 18, 2016: Journal of Anesthesia
https://www.readbyqxmd.com/read/27724970/the-pre-hospital-administration-of-tranexamic-acid-to-patients-with-multiple-injuries-and-its-effects-on-rotational-thrombelastometry-a-prospective-observational-study-in-pre-hospital-emergency-medicine
#3
Nils Kunze-Szikszay, Lennart A Krack, Pauline Wildenauer, Saskia Wand, Tim Heyne, Karoline Walliser, Christopher Spering, Martin Bauer, Michael Quintel, Markus Roessler
BACKGROUND: Hyperfibrinolysis (HF) is a major contributor to coagulopathy and mortality in trauma patients. This study investigated (i) the rate of HF during the pre-hospital management of patients with multiple injuries and (ii) the effects of pre-hospital tranexamic acid (TxA) administration on the coagulation system. METHODS: From 27 trauma patients with pre-hospital an estimated injury severity score (ISS) ≥16 points blood was obtained at the scene and on admission to the emergency department (ED)...
October 10, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27722160/monitoring-and-treatment-of-coagulation-disorders-in-end-stage-liver-disease
#4
REVIEW
Fuat H Saner, Carmen Kirchner
BACKGROUND: Patients with end-stage liver disease (ESLD) are assumed to be at high risk of bleeding when undergoing any kind of invasive intervention (any kind of operation, including transplantation or minimally invasive interventions). Both bleeding and thrombosis are associated with a poor outcome. METHODS: A selective literature research was conducted with the following key words: 'cirrhosis', 'coagulation', 'bleeding', 'INR' (international normalized ratio), 'aPTT' (activated partial thromboplastin time), and 'thrombocytopenia'...
August 2016: Visceral Medicine
https://www.readbyqxmd.com/read/27716278/a-systematic-review-on-the-rotational-thrombelastometry-rotem%C3%A2-values-for-the-diagnosis-of-coagulopathy-prediction-and-guidance-of-blood-transfusion-and-prediction-of-mortality-in-trauma-patients
#5
Precilla V Veigas, Jeannie Callum, Sandro Rizoli, Bartolomeu Nascimento, Luis Teodoro da Luz
INTRODUCTION: Viscoelastic assays have been promoted as an improvement over traditional coagulation tests in the management of trauma patients. Rotational thromboelastometry (ROTEM®) has been used to diagnose coagulopathy and guide hemostatic therapy in trauma. This systematic review of clinical studies in trauma investigates the ROTEM® parameters thresholds used for the diagnosing coagulopathy, predicting and guiding transfusion and predicting mortality. METHODS: Systematic literature search was performed using MEDLINE, EMBASE and Cochrane databases...
October 3, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27692703/targeted-bleeding-management-reduces-the-requirements-for-blood-component-therapy-in-lung-transplant-recipients
#6
Ian Smith, Bronwyn L Pearse, Daniel J Faulke, Rishen Naidoo, Lisa Nicotra, Peter Hopkins, Elizabeth G Ryan
OBJECTIVE: Lung transplantation is associated with high rates of bleeding and frequent blood transfusion. The authors aimed to determine if point-of-care coagulation testing (POCCT) reduced transfusion requirements. DESIGN, SETTINGS, AND PARTICIPANTS: A before-and-after cohort analysis conducted at a single tertiary referral center. Ninety-three sequential adult patients between January 2010 and January 2014 undergoing isolated lung transplant without preoperative extracorporeal support were analyzed...
June 27, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27658942/algorithm-for-activation-of-coagulation-support-treatment-in-multiple-injured-patients-cohort-study
#7
D Brilej, D Stropnik, R Lefering, R Komadina
BACKGROUND: Early recognition and management of trauma related coagulopathy improves the outcome. Trauma facilities should implement an algorithm to identify the bleeding trauma patient with coagulopathy. OBJECTIVE: The scope of the paper is to identify the indicators of early coagulopathy and to optimize the indications for thromboelastometry and coagulation support. DESIGN: Cohort study based on data from trauma registry. SETTING: Data of 493 major trauma patients treated in GH Celje from 2006 to 2014 were included into The TraumaRegister DGU(®) (TR-DGU)...
September 22, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/27650566/-the-role-of-rotational-thromboelastometry-rotem-in-the-perioperative-period-in-a-warfarinized-patient-case-report
#8
M Durila, J Schützner, T Vymazal
UNLABELLED: Warfarin overdose with unmeasurable values of the prothrombin time (PT-INR) is a significant problem in the preoperative preparation of the patient for acute invasive surgery. In contrast to conventional blood clotting assays, rotational thromboelastometry (ROTEM) evaluates the coagulation profile of the whole blood and provides a more complex view of the coagulation status of the patient. Thromboelastometry results are available within about 10 minutes and help us to provide targeted "bedside" therapy of coagulopathy in a bleeding patient...
2016: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
https://www.readbyqxmd.com/read/27589544/use-of-uterine-artery-embolization-to%C3%A2-prevent-peripartum-hemorrhage-of-placental-abruption-with-fetal-demise-severe-dic
#9
E Latif, S Adam, B Rungruang, A Al-Hendy, M P Diamond, E Rotem, J Cannell, P C Browne
Uterine artery embolization (UAE) is typically not indicated in the pre-operative management of pregnancies with a live fetus, because risk of fetal death from reduced uteroplacental blood flow. However, pre-operative UAE in pregnancies with a fetal demise poses no fetal risk, and may offer maternal benefits. Patients with placental abruption resulting in fetal demise are at high-risk for developing disseminated intravascular coagulation (DIC), which could have devastating complications such as peri-operative hemorrhage and death...
September 16, 2016: Journal of Neonatal-perinatal Medicine
https://www.readbyqxmd.com/read/27363652/point-of-care-thromboelastography-thromboelastometry-based-coagulation-management-in-cardiac-surgery-a-meta-analysis-of%C3%A2-8332-patients
#10
Antje-Christin Deppe, Carolyn Weber, Julia Zimmermann, Elmar W Kuhn, Ingo Slottosch, Oliver J Liakopoulos, Yeong-Hoon Choi, Thorsten Wahlers
OBJECTIVES: Severe bleeding related to cardiac surgery is associated with increased morbidity and mortality. Thromboelastography (TEG) and thromboelastometry (ROTEM) are point-of-care tests (POCT). Bedside ROTEM/TEG can rapidly detect changes in blood coagulation and therefore provide a goal-directed, individualized coagulation therapy. In this meta-analysis, we aimed to determine the current evidence for or against POCT-guided algorithm in patients with severe bleeding after cardiac surgery...
June 15, 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27354213/is-viscoelastic-coagulation-monitoring-with-rotem-or-teg-validated
#11
Cristina Solomon, Lars M Asmis, Donat R Spahn
Recent years have seen increasing worldwide interest in the use of viscoelastic coagulation monitoring tests, performed using devices such as ROTEM and TEG. The use of such tests to guide haemostatic therapy may help reduce transfusion of allogeneic blood products in bleeding patients and is supported in European guidelines for managing trauma and severe perioperative bleeding. In addition, viscoelastic tests form the basis of numerous published treatment algorithms. However, some publications have stated that viscoelastic tests are not validated...
October 2016: Scandinavian Journal of Clinical and Laboratory Investigation
https://www.readbyqxmd.com/read/27264484/the-utility-of-thromboelastography-in-inherited-and-acquired-bleeding-disorders
#12
REVIEW
Keiji Nogami
Thromboelastography (TEG) was first described by Hartert in 1948, and was designed to monitor viscoelastic clot strength in whole blood in real time. The current TEG method and Rotational Thromboelastometry (ROTEM) were subsequently developed from the original principles. Both of the modern methods provide data by measuring changes in the viscoelastic strength of a small sample of clotting blood in response to a constant rotational force. The important advantage of these techniques is to visually observe and quantify blood coagulation including the propagation, stabilization and dissolution phases of clot formation under low shear conditions...
August 2016: British Journal of Haematology
https://www.readbyqxmd.com/read/27192467/correlation-between-laboratory-coagulation-testing-and-thromboelastometry-is-modified-during-management-of-trauma-patients
#13
Jean-Stéphane David, Maeva Durand, Albrice Levrat, Mathilde Lefevre, Lucia Rugeri, Marie-Odile Geay-Baillat, Kenji Inaba, Pierre Bouzat
BACKGROUND: Thromboelastometry (ROTEM, Pentapharm GmbH, Munich, Germany) is increasingly being used to make a diagnosis of coagulopathy and to guide hemostatic therapy (HT). Although ROTEM parameters and standard laboratory test (SLT) correlated well before administration of HT, it is not known if this correlation persists after hemostatic resuscitation. METHODS: A retrospective analysis of prospectively collected data from a trauma registry (2011-2014) was performed...
August 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27188788/point-of-care-based-protocol-with-first-line-therapy-with-coagulation-factor-concentrates-is-associated-with-decrease-allogenic-blood-transfusion-and-costs-in-cardiovascular-surgery-an-italian-single-center-experience
#14
Davide Trevisan, Laura Zavatti, Davide Gabbieri, Marco Pedulli, Gianbeppe Giordano, Marco Meli
BACKGROUND: Transfusion in patients having cardiac surgery has been associated with increased morbidity, mortality, and costs. This analysis assessed the impact of a rotational thromboelastometry (ROTEM®)- and functional platelet assessment (Multiplate®)-based protocol for bleeding management on perioperative outcomes and costs in patients undergoing cardiac surgery. METHODS: This retrospective analysis of the records of all patients who underwent cardiac surgery at the Hesperia Hospital, Modena, Italy, from December 2012 to December 2013 compared outcomes and costs of bleeding management for the two 6-month periods before/after introduction of the ROTEM- and Multiplate-based protocol...
May 18, 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27129380/influence-of-temperature-on-thromboelastometry-and-platelet-aggregation-in-cardiac-arrest-patients-undergoing-targeted-temperature-management
#15
Anni Nørgaard Jeppesen, Hans Kirkegaard, Susanne Ilkjær, Anne Mette Hvas
BACKGROUND: Coagulation can be visualised using whole blood coagulation analyses such as thromboelastometry and platelet aggregation tests; however, the role of temperature in the analyses is ambiguous. The aim was to examine whether temperature influences the whole blood coagulation tests. METHODS: We included 40 patients treated with targeted temperature management (33 ± 1 °C) after out-of-hospital cardiac arrest. The blood samples were obtained on hypothermia and normothermia...
2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27028451/point-of-care-coagulation-management-algorithms-during-ecmo-support-are-we-there-yet
#16
Daniel Bolliger, Urs Zenklusen, Kenichi A Tanaka
Haemorrhagic and thromboembolic events are common and the main cause for morbidity and mortality in patients treated with extracorporeal membrane oxygenation (ECMO). Monitoring of an adequate anticoagulation is, therefore, essential in patients during ECMO therapy. This review aims to describe the current evidence and emerging data relating to anticoagulation therapy and point-of-care (POC) coagulation monitoring in ECMO patients. Central laboratory-based coagulation testing including activated partial thromboplastin time (aPTT), international normalized ratio (INR) of the prothrombin time (PT), and activated clotting time (ACT) is most commonly used for coagulation monitoring...
March 30, 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/26619853/practice-management-of-acute-trauma-haemorrhage-and-haemostatic-disorders-across-german-trauma-centres
#17
V Albrecht, N Schäfer, E K Stürmer, A Driessen, L Betsche, M Schenk, M Maegele
PURPOSE: Early detection and management of trauma haemorrhage and coagulopathy have been associated with improved outcomes. We assessed infrastructure, logistics and management practice of trauma-associated haemorrhage and coagulopathy across German trauma centres. METHODS: A web-based survey of 20 questions was developed using the open source survey application LimeSurvey(®). It was disseminated among surgeons and anaesthetists in Germany. RESULTS: 145 Questionnaires were returned of which 106 were completed and analysed...
November 30, 2015: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/26610182/ex-vivo-evaluation-of-4-different-viscoelastic-assays-for-detecting-moderate-to-severe-coagulopathy-during-liver-transplantation
#18
Ezeldeen Abuelkasem, Michael A Mazzeffi, Shu Yang Lu, Raymond M Planinsic, Tetsuro Sakai, Kenichi A Tanaka
Prolonged prothrombin time (PT) and its ratio are routinely used for the assessment of candidates for liver transplantation (LT), but intraoperative coagulation management of transfusion is hindered by its long turnaround time. Abnormal reaction time (R time) on thromboelastography (TEG) or clotting time (CT) of rotational thromboelastometry (ROTEM) are presumably an alternative, but there is a paucity of clinical data on abnormal R time/CT values compared to PT during LT. After receiving institutional review board approval and informed consent, we obtained blood samples from 36 LT patients for international normalized ratio (INR), factor (F) X level, and viscoelastic tests (EXTEM/INTEM and kaolin/rapid TEG) at baseline and 30 minutes after graft reperfusion...
April 2016: Liver Transplantation
https://www.readbyqxmd.com/read/26457895/economic-aspects-of-intraoperative-coagulation-management-targeting-higher-fibrinogen-concentrations-during-major-craniosynostosis-surgery
#19
RANDOMIZED CONTROLLED TRIAL
Thorsten Haas, Nelly Spielmann, Tanja Restin, Alexander R Schmidt, Markus Schmugge, Melissa M Cushing
BACKGROUND: Results of a previously published study demonstrated a significant decrease in transfusion requirements and calculated blood loss for pediatric major craniosynostosis surgery, if a ROTEM(®) FIBTEM trigger of <13 mm (early substitution group) was applied as compared to a trigger of <8 mm (conventional group). The aim of this study was a posthoc analysis of the costs for this coagulation management. METHODS: The total volume as well as the number of units or bags for all transfused blood products and coagulation factors were recorded for each case...
January 2016: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/26375080/hem-18-variations-in-infrastructure-logistics-and-clinical-practice-for-the-detection-and-management-of-trauma-associated-haemorrhage-and-coagulopathy-across-trauma-centres-in-germany
#20
V Albrecht, E Stürmer, A Driessen, M Schenk, L Betsche, M Maegele
INTRODUCTION: Early detection of trauma haemorrhage and coagulopathy has been associated with improved outcomes. We assessed infrastructure, logistics and management of trauma haemorrhage and coagulopathy across German trauma centres. METHODS: An online-survey (20 questions) was developed and analysed using the open source survey application LimeSurvey®. It was disseminated among surgeons and anaesthetists in Germany. Hospitals of all levels were addressed. RESULTS: 106 questionnaires were completed and analysed...
October 2015: Shock
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