Stéphanie Roullet1, Emmanuel de Maistre2, Brigitte Ickx3, Normand Blais4, Sophie Susen5, David Faraoni6, Delphine Garrigue7, Fanny Bonhomme8, Anne Godier9, Dominique Lasne10. 1. Inserm U 12-11, service anesthésie-réanimation 1, université de Bordeaux, CHU de Bordeaux, 33000 Bordeaux, France. Electronic address: stephanie.roullet@chu-bordeaux.fr. 2. Unité d'hémostase, centre hospitalier universitaire, 21079 Dijon, France. 3. Université Libre de Bruxelles, Erasme University Hospital, Department of Anesthesiology, Brussels, Belgium. 4. Hématologie et oncologie médicale, CHUM, Montréal, Canada. 5. Institut d'hématologie et transfusion, CHRU de Lille, 59037 Lille, France. 6. Department of Anaesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada. 7. Pôle d'anesthésie-réanimation, CHRU de Lille, 59037 Lille, France. 8. Service d'anesthésiologie, hôpital universitaire de Genève, Geneva, Switzerland. 9. Service d'anesthésie-réanimation, Fondation Rothschild, 75019 Paris, France. 10. Laboratoire d'hématologie, hôpital Necker, 75015 Paris, France.
Abstract
PURPOSE: Viscoelastic tests (VETs), thromboelastography (TEG®) and thromboelastometry (ROTEM®) are global tests of coagulation performed on whole blood. They evaluate the mechanical strength of a clot as it builds and develops after coagulation itself. The time required to obtain haemostasis results remains a major problem for clinicians dealing with bleeding, although some teams have developed a rapid laboratory response strategy. Indeed, the value of rapid point-of-care diagnostic devices such as VETs has increased over the years. However, VETs are not standardised and there are few recommendations from the learned societies regarding their use. In 2014, the recommendations of the International Society of Thrombosis and Haemostasis (ISTH) only concerned haemophilia. The French Working Group on Perioperative haemostasis (GIHP) therefore proposes to summarise knowledge on the clinical use of these techniques in the setting of emergency and perioperative medicine. METHODS: A review of the literature. PRINCIPAL FINDINGS: The role of the VETs seems established in the management of severe trauma and in cardiac surgery, both adult and paediatric. In other situations, their role remains to be defined: hepatic transplantation, postpartum haemorrhage, and non-cardiac surgery. They must be part of the global management of haemostasis based on algorithms defined in each centre and for each population of patients. Their position at the bedside or in the laboratory is a matter of discussion between clinicians and biologists. CONCLUSION: VETs must be included in algorithms. In consultation with the biology laboratory, these devices should be situated according to the way each centre functions.
PURPOSE: Viscoelastic tests (VETs), thromboelastography (TEG®) and thromboelastometry (ROTEM®) are global tests of coagulation performed on whole blood. They evaluate the mechanical strength of a clot as it builds and develops after coagulation itself. The time required to obtain haemostasis results remains a major problem for clinicians dealing with bleeding, although some teams have developed a rapid laboratory response strategy. Indeed, the value of rapid point-of-care diagnostic devices such as VETs has increased over the years. However, VETs are not standardised and there are few recommendations from the learned societies regarding their use. In 2014, the recommendations of the International Society of Thrombosis and Haemostasis (ISTH) only concerned haemophilia. The French Working Group on Perioperative haemostasis (GIHP) therefore proposes to summarise knowledge on the clinical use of these techniques in the setting of emergency and perioperative medicine. METHODS: A review of the literature. PRINCIPAL FINDINGS: The role of the VETs seems established in the management of severe trauma and in cardiac surgery, both adult and paediatric. In other situations, their role remains to be defined: hepatic transplantation, postpartum haemorrhage, and non-cardiac surgery. They must be part of the global management of haemostasis based on algorithms defined in each centre and for each population of patients. Their position at the bedside or in the laboratory is a matter of discussion between clinicians and biologists. CONCLUSION: VETs must be included in algorithms. In consultation with the biology laboratory, these devices should be situated according to the way each centre functions.
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