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TEG ROTEM fibrinogen

Samy Figueiredo, Audrey Tantot, Jacques Duranteau
Viscoelastic hemostatic assays (VHAs), mainly thromboelastography (TEG) and the rotational thromboelastometry (ROTEM), provide global information on clot formation and dissolution at patient bedside, allowing fast identification of coagulation disorders. In trauma patients, VHAs are able to predict massive transfusion and mortality. These devices might also be used for applying targeted administration of procoagulant factors (e.g. fibrinogen concentrate) as an alternative to or in addition to using predefined fixed ratios of red blood cells: platelets: fresh frozen plasma/cryoprecipitate...
November 2016: Minerva Anestesiologica
Florian Prüller, Harald Mangge
No abstract text is available yet for this article.
September 1, 2016: Clinical Chemistry and Laboratory Medicine: CCLM
Sandro Rizoli, Arimie Min, Adic Perez Sanchez, Pang Shek, Richard Grodecki, Precilla Veigas, Henry T Peng
BACKGROUND: There is growing interest in viscoelastic hemostatic assays rotational thromboelastometry (ROTEM) and thromboelastography (TEG) for trauma. Despite shared features, it is unknown whether their results are interchangeable and whether one is clinically superior in predicting mortality, blood transfusion, and diagnosing early trauma coagulopathy. METHODS: We conducted a prospective observational study comparing equivalent ROTEM and TEG parameters. Severely injured patients expected to receive massive transfusion were included...
May 2016: Military Medicine
Herbert Schöchl, Oliver Grottke, Marc Maegele
No abstract text is available yet for this article.
September 1, 2016: Clinical Chemistry and Laboratory Medicine: CCLM
Donat R Spahn, Gabriela H Spahn, Philipp Stein
Fibrinogen has a central role in coagulation. Following trauma and perioperatively, low fibrinogen levels have been found to be risk factors for exaggerated bleeding, transfusion needs, and adverse outcome. Conversely, treatment with exogenous fibrinogen in critically bleeding patients with low fibrinogen levels has been shown to decrease transfusion needs. Because following trauma and in many perioperative situations fibrinogen is the first coagulation "element" to become critically low, it appears reasonable to target fibrinogen in clinical coagulation algorithms aiming at early specific and goal-directed treatment...
March 2016: Seminars in Thrombosis and Hemostasis
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
Cristina Solomon, Marco Ranucci, Gerald Hochleitner, Herbert Schöchl, Christoph J Schlimp
The viscoelastic properties of blood clot have been studied most commonly using thrombelastography (TEG) and thromboelastometry (ROTEM). ROTEM-based bleeding treatment algorithms recommend administering platelets to patients with low EXTEM clot strength (e.g., clot amplitude at 10 minutes [A10] <40 mm) once clot strength of the ROTEM® fibrin-based test (FIBTEM) is corrected. Algorithms based on TEG typically use a low value of maximum amplitude (e.g., <50 mm) as a trigger for administering platelets...
October 2015: Anesthesia and Analgesia
Florian Prüller, Andreas Münch, Astrid Preininger, Reinhard Bernd Raggam, Yvonne Grinschgl, Jakub Krumnikl, Wolfgang Toller, Hellfried Metzler, Elisabeth Mahla, Harald Mangge
BACKGROUND: Fibrinogen-based clot firmness is reported as the maximum amplitude (MA) when using the citrated functional fibrinogen (CFF) assay in thrombelastography (TEG), and as the maximum clot firmness (MCF) together with several clot amplitude parameters when using the FIBTEM assay in thromboelastometry (ROTEM). Concern is currently being raised that these two tests have different platelet inhibiting performance and consequently provide different values. This is relevant for the clinical setting of fibrinogen replacement...
March 2016: Clinical Chemistry and Laboratory Medicine: CCLM
Cristina Solomon, Herbert Schöchl, Marco Ranucci, Christoph J Schlimp
Viscoelastic tests such as thrombelastography (TEG, Haemoscope Inc., Niles, IL) and thromboelastometry (ROTEM, Tem International GmbH, Munich, Germany), performed in whole blood, are increasingly used at the point-of-care to characterize coagulopathic states and guide hemostatic therapy. An algorithm, based on a mono-analysis (kaolin-activated assay) approach, was proposed in the TEG patent (issued in 2004) where the α-angle and the maximum amplitude parameters are used to guide fibrinogen supplementation and platelet administration, respectively...
August 2015: Anesthesia and Analgesia
M Maegele, K Inaba, S Rizoli, P Veigas, J Callum, R Davenport, M Fröhlich, J Hess
Although there is increasing interest in the use of a viscoelastic test procedure (ROTEM/TEG) for diagnostics and therapy guidance of severely injured and bleeding patients, currently no uniformly accepted guidelines exist for how this technology should be integrated into clinical treatment. In September 2014 an international multidisciplinary group of opinion leaders in the field of trauma-induced coagulopathy and other disciplines involved in the treatment of severely injured patients were assembled for a 2-day consensus conference in Philadelphia (USA)...
October 2015: Der Anaesthesist
J N Harr, E E Moore, T L Chin, M P Chapman, A Ghasabyan, J R Stringham, A Banerjee, C C Silliman
PURPOSE: Viscoelastic hemostatic assays are emerging as the standard-of-care in the early detection of post-injury coagulopathy. TEG and ROTEM are most commonly used. Although similar in technique, each uses different reagents, which may affect their sensitivity to detect fibrinolysis. Therefore, the purpose of this study is to determine the ability of each device to detect fibrinolysis. METHODS: TEG (Rapid, Kaolin, Functional Fibrinogen) and ROTEM (EXTEM, INTEM, FIBTEM) were run simultaneously on normal blood as well as blood containing tPA from healthy volunteers (n = 10)...
February 2015: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
E Ortmann, A Rubino, B Altemimi, T Collier, M W Besser, A A Klein
BACKGROUND: Viscoelastic point-of-care tests such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are increasingly used to guide hemostatic therapy after cardiac surgery. The aim of this study was to assess their clinical utility during cardiopulmonary bypass to predict postbypass coagulation status and to guide therapy. METHODS: In this prospective study, TEG and ROTEM tests were performed in 52 adult patients undergoing elective cardiac surgery at two time points: near the end of cardiopulmonary bypass and after heparin reversal with protamine...
July 2015: Journal of Thrombosis and Haemostasis: JTH
Kim Ekelund, Gabriele Hanke, Jakob Stensballe, Anne Wikkelsøe, Charlotte Krebs Albrechtsen, Arash Afshari
BACKGROUND: Postpartum hemorrhage is a potentially life-threatening albeit preventable condition that persists as a leading cause of maternal death. Identification of safe and cost-effective hemostatic treatment options remains crucial as a supplement to surgery and uterotonic agents. OBJECTIVE: This review summarizes the background, current evidence and recommendations with regard to the role of fibrinogen, tranexamic acid, prothrombin complex concentrate, desmopressin, and recombinant factor VIIa in the treatment of patients with postpartum hemorrhage...
July 2015: Acta Obstetricia et Gynecologica Scandinavica
Aurora Espinosa, Roar Stenseth, Vibeke Videm, Hilde Pleym
BACKGROUND: Bleeding complications in cardiac surgery may lead to increased morbidity and mortality. Traditional blood coagulation tests are not always suitable to detect rapid changes in the patient's coagulation status. Point-of-care instruments such as the TEG (thromboelastograph) and RoTEM (thromboelastometer) have been shown to be useful as a guide for the clinician in the choice of blood products and they may lead to a reduction in the need for blood transfusion, contributing to better patient blood management...
2014: BMC Anesthesiology
Lynne Anderson, Isma Quasim, Mark Steven, Stephen F Moise, Ben Shelley, Stefan Schraag, Andrew Sinclair
OBJECTIVES: Near-patient viscoelastic tests have proved useful in decreasing blood and blood product use in cardiac surgery. Two different analyzers are available, TEG and ROTEM. Many different individuals operate these devices, which raises concern that this factor may significantly affect results. The present study sought to objectively assess variability in results between operators. DESIGN: Prospective study. SETTING: Regional cardiac center...
December 2014: Journal of Cardiothoracic and Vascular Anesthesia
Anna Sina P Meyer, Martin A S Meyer, Anne Marie Sørensen, Lars S Rasmussen, Morten B Hansen, John B Holcomb, Bryan A Cotton, Charles E Wade, Sisse R Ostrowski, Pär I Johansson
BACKGROUND: Viscoelastic hemostatic assays may provide means for earlier detection of trauma-induced coagulopathy (TIC). METHODS: This is a prospective observational study of 182 trauma patients admitted to a Level 1 trauma center. Clinical data, thrombelastography (TEG), and rotational thromboelastometry (ROTEM) parameters were recorded upon arrival. Citrated kaolin (CK), rapid TEG (rTEG), and functional fibrinogen curves were extracted, and early amplitudes A5 and A10 were registered...
March 2014: Journal of Trauma and Acute Care Surgery
H Schöchl, C J Schlimp, W Voelckel
Exsanguination represents the most common and potentially preventable cause of death in major trauma patients. Rapid surgical intervention coupled with an early and aggressive hemostatic therapy not only results in survival benefits of coagulopathic trauma patients, but also reduces the incidence of complications and costs. Standard coagulation tests are not suitable to adequately characterize the complexity of trauma-induced coagulopathy (TIC). This fact has led to a renaissance of viscoelastic tests, such as rotational thromboelastometry (ROTEM®) and thrombelastography (TEG®), which can be used as point-of-care monitors...
February 2014: Der Unfallchirurg
Christoph J Schlimp, Cristina Solomon, Marco Ranucci, Gerald Hochleitner, Heinz Redl, Herbert Schöchl
BACKGROUND: Viscoelastic tests such as functional fibrinogen polymerization assays (FFPAs) in thrombelastography (TEG®) or thromboelastometry (ROTEM®) measure clot elasticity under platelet inhibition. Incomplete platelet inhibition influences maximum clot firmness (MCF) of FFPAs. We compared the ability of existing and newly developed FFPAs to eliminate the platelet contribution to clot strength. METHODS: MCF of whole blood (WB), platelet-rich plasma (PRP), and platelet-poor plasma samples was recorded using a ROTEM device with different FFPAs, including the TEG functional fibrinogen test (FFTEG) and different ROTEM-based assays: the standard fib-tem reagent (FIBTEM), a lyophilized single-portion reagent fib-tem S (FIBTEM-S), a newly developed reagent FIBTEM PLUS, as well as FIBTEM or the standard extrinsic activation reagent ex-tem® (EXTEM) combined with 10-μg abciximab (FIBTEM-ABC/EXTEM-ABC)...
February 2014: Anesthesia and Analgesia
David Whiting, James A DiNardo
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...
February 2014: American Journal of Hematology
Daniel Bolliger, Kenichi A Tanaka
The value of thrombelastography (TEG) and thromboelastometry (ROTEM) to improve perioperative hemostasis is under debate. We aimed to assess the effects of TEG- or ROTEM-guided therapy in patients undergoing cardiac surgery on the use of allogeneic blood products. We analyzed 12 trials including 6835 patients, 749 of them included in 7 randomized controlled trials (RCTs). We collected data on the amount of transfused allogeneic blood products and on the proportion of patients who received allogeneic blood products or coagulation factor concentrates...
October 2013: Transfusion Medicine Reviews
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