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). A two-tailed, paired t-test and ANOVA were used to determine the significance between parameters obtained from normal blood and blood with tPA, and individual TEG and ROTEM assays, respectively. RESULTS: TEG detected significant changes in clot strength and 30-min lysis after the addition of tPA (p < 0.0001). All ROTEM assays detected changes in the 30-min lysis (p < 0.0001), but only INTEM detected changes in clot strength (p < 0.05). Kaolin and Rapid TEG assays detected greater changes in clot strength and lysis, but INTEM and EXTEM had decreased lysis onset times compared to TEG (p < 0.001). Functional Fibrinogen and FIBTEM assays detected lysis sooner than other TEG/ROTEM assays, and were comparable. CONCLUSIONS: TEG assays detect greater changes in clot strength compared to ROTEM. Despite this, Functional Fibrinogen and FIBTEM assays detect fibrinolysis sooner than their corresponding intrinsic and extrinsic assays. Therefore, fibrinogen assays should be employed in actively bleeding trauma patients in order to provide timely antifibrinolytic therapy.
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). A two-tailed, paired t-test and ANOVA were used to determine the significance between parameters obtained from normal blood and blood with tPA, and individual TEG and ROTEM assays, respectively. RESULTS:TEG detected significant changes in clot strength and 30-min lysis after the addition of tPA (p < 0.0001). All ROTEM assays detected changes in the 30-min lysis (p < 0.0001), but only INTEM detected changes in clot strength (p < 0.05). Kaolin and Rapid TEG assays detected greater changes in clot strength and lysis, but INTEM and EXTEM had decreased lysis onset times compared to TEG (p < 0.001). Functional Fibrinogen and FIBTEM assays detected lysis sooner than other TEG/ROTEM assays, and were comparable. CONCLUSIONS:TEG assays detect greater changes in clot strength compared to ROTEM. Despite this, Functional Fibrinogen and FIBTEM assays detect fibrinolysis sooner than their corresponding intrinsic and extrinsic assays. Therefore, fibrinogen assays should be employed in actively bleeding traumapatients in order to provide timely antifibrinolytic therapy.
Authors: Klaus Martin; Jürgen Knorr; Tamás Breuer; Ralph Gertler; Martin Macguill; Rüdiger Lange; Peter Tassani; Gunther Wiesner Journal: J Cardiothorac Vasc Anesth Date: 2011-02 Impact factor: 2.628
Authors: Michael P Chapman; Ernest E Moore; Christopher R Ramos; Arsen Ghasabyan; Jeffrey N Harr; Theresa L Chin; John R Stringham; Angela Sauaia; Christopher C Silliman; Anirban Banerjee Journal: J Trauma Acute Care Surg Date: 2013-12 Impact factor: 3.313
Authors: Ian Roberts; Haleema Shakur; Adefemi Afolabi; Karim Brohi; Tim Coats; Yashbir Dewan; Satoshi Gando; Gordon Guyatt; B J Hunt; Carlos Morales; Pablo Perel; David Prieto-Merino; Tom Woolley Journal: Lancet Date: 2011-03-26 Impact factor: 79.321
Authors: Jeffrey N Harr; Ernest E Moore; Theresa L Chin; Arsen Ghasabyan; Eduardo Gonzalez; Max V Wohlauer; Anirban Banerjee; Christopher C Silliman; Angela Sauaia Journal: J Trauma Acute Care Surg Date: 2013-03 Impact factor: 3.313
Authors: Bryan A Cotton; John A Harvin; Vadim Kostousouv; Kristin M Minei; Zayde A Radwan; Herbert Schöchl; Charles E Wade; John B Holcomb; Nena Matijevic Journal: J Trauma Acute Care Surg Date: 2012-08 Impact factor: 3.313
Authors: Antoni R Macko; Hunter B Moore; Andrew P Cap; M Adam Meledeo; Ernest E Moore; Forest R Sheppard Journal: J Trauma Acute Care Surg Date: 2017-04 Impact factor: 3.313
Authors: Hunter B Moore; Matthew D Neal; Marnie Bertolet; Brian A Joughin; Michael B Yaffe; Christopher D Barrett; Molly A Bird; Russell P Tracy; Ernest E Moore; Jason L Sperry; Brian S Zuckerbraun; Myung S Park; Mitchell J Cohen; Stephen R Wisniewski; James H Morrissey Journal: Ann Surg Open Date: 2022-05-25
Authors: Ernest E Moore; Hunter B Moore; Lucy Z Kornblith; Matthew D Neal; Maureane Hoffman; Nicola J Mutch; Herbert Schöchl; Beverley J Hunt; Angela Sauaia Journal: Nat Rev Dis Primers Date: 2021-04-29 Impact factor: 65.038
Authors: Klaus Görlinger; Antonio Pérez-Ferrer; Daniel Dirkmann; Fuat Saner; Marc Maegele; Ángel Augusto Pérez Calatayud; Tae-Yop Kim Journal: Korean J Anesthesiol Date: 2019-05-17