Basic Principles of Rotational Thromboelastometry (ROTEM®) and the Role of ROTEM—Guided Fibrinogen Replacement Therapy in the Management of Coagulopathies

Drotarova, Miroslava; Zolkova, Jana; Belakova, Kristina; Brunclikova, Monika; Skornova, Ingrid; Stasko, Jan; Simurda, Tomas

doi:10.3390/diagnostics13203219

Cited by 10 publications

(4 citation statements)

References 52 publications

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“…ClotPro ® is a relatively new device that is increasingly being used in Europe and worldwide [16,18,[28][29][30][31]. In current clinical practice, ClotPro ® viscoelastic hemostatic assays have been used, but therapeutic consequences continue to be deduced from established algorithms based on ROTEM ® or TEG parameters [11,12,32,33]. However, data from cardiac surgery and critically ill COVID-19 patients have suggested that ROTEM ® and ClotPro ® parameters cannot be used interchangeably.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Two Viscoelastic Testing Devices in a Parturient Population

Gruneberg,

Hofer,

Schöchl

et al. 2024

JCM

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Background: Viscoelastic hemostatic assays (VHAs) have become an integral diagnostic tool in guiding hemostatic therapy, offering new opportunities in personalized hemostatic resuscitation. This study aims to assess the interchangeability of ClotPro® and ROTEM® delta in the unique context of parturient women. Methods: Blood samples from 217 parturient women were collected at three timepoints. A total of 631 data sets were eligible for our final analysis. The clotting times were analyzed via extrinsic and intrinsic assays, and the clot firmness parameters A5, A10, and MCF were analyzed via extrinsic, intrinsic, and fibrin polymerization assays. In parallel, the standard laboratory coagulation statuses were obtained. Device comparison was assessed using regression and Bland–Altman plots. The best cutoff calculations were used to determine the VHA values corresponding to the established standard laboratory cutoffs. Results: The clotting times in the extrinsic and intrinsic assays showed notable differences between the devices, while the extrinsic and intrinsic clot firmness results demonstrated interchangeability. The fibrinogen assays revealed higher values in ClotPro® compared to ROTEM®. An ROC analysis identified VHA parameters with high predictive values for coagulopathy exclusion and yet low specificity. Conclusions: In the obstetric setting, the ROTEM® and ClotPro® parameters demonstrate a significant variability. Device- and indication-specific transfusion algorithms are essential for the accurate interpretation of measurements and adequate hemostatic therapy.

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Section: Discussionmentioning

confidence: 99%

“…Currently, a variety of VHA-based transfusion algorithms exist. These algorithms are based mainly on established devices like ROTEM ® and TEG ® [11][12][13]. The ClotPro ® hemostatic device is a new point-of-care monitor for viscoelastic testing.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Two Viscoelastic Testing Devices in a Parturient Population

Gruneberg,

Hofer,

Schöchl

et al. 2024

JCM

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“…Rotational thromboelastometry is a viscoelastic method that allows to quickly assess the state of induced hemostasis in whole blood samples and to effectively reduce the number of transfusions, healthcare costs, and complications [20]. The pressure of blood flowing through a cirrhotic liver can be reduced via the placement of a transjugular intrahepatic portosystemic shunt (TIPS) and is employed for treating refractory ascites and/or variceal bleeding [21].…”

Section: Liver Cirrhosismentioning

confidence: 99%

Liver Diseases: Science, Fiction and the Foreseeable Future

Gieseler,

Baars,

Özçürümez

et al. 2024

JPM

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This Editorial precedes the Special Issue entitled “Novel Challenges and Therapeutic Options for Liver Diseases”. Following a historical outline of the roots of hepatology, we provide a brief insight into our colleagues’ contributions in this issue on the current developments in this discipline related to the prevention of liver diseases, the metabolic dysfunction-associated steatotic liver disease (or non-alcoholic fatty liver disease, respectively), liver cirrhosis, chronic viral hepatitides, acute-on-chronic liver failure, liver transplantation, the liver–microbiome axis and microbiome transplantation, and telemedicine. We further add some topics not covered by the contributions herein that will likely impact future hepatology. Clinically, these comprise the predictive potential of organokine crosstalk and treatment options for liver fibrosis. With regard to promising developments in basic research, some current findings on the genetic basis of metabolism-associated chronic liver diseases, chronobiology, metabolic zonation of the liver, aspects of the aging liver against the background of demography, and liver regeneration will be presented. We expect machine learning to thrive as an overarching topic throughout hepatology. The largest study to date on the early detection of liver damage—which has been kicked off on 1 March 2024—is highlighted, too.

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“…На дзеркальце, прикріплене до осі коливального штифта, спрямований світловий промінь. Поступово навколо штифта утворюється згорток, який обмежує коливання штифта, і зміни відбиття променя фіксуються фотоприймачем [5]. Графічне відображення зафіксованих змін формує тромбоеластометричну криву, спираючись на форму якої оцінюють коагуляцію від утворення згортка через його ущільнення і стабілізацію до розчинення в процесі фібринолізу.…”

Section: оригінальні дослідженняunclassified

Indicators of rotational thromboelastometry in preterm delivery

Leush,

Protsyk

2024

UJHW

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Disrupted maternal, placental, and/or fetal hemostasis leads to gestational disorders, including preterm birth (PR). A quick and convenient assessment of the coagulation profile is important for a premature newborn. Aim - to compare the indicators of hemostasis in mothers and newborns with different gestational ages using rotational thromboelastometry. Materials and methods. The study analyzed the indicators of the hemostatic profile in women in labor and their newborns using the fib-tem test on the ROTEM® delta device. Three groups of mothers and their newborns were studied: the Group I - at a gestation period of 37-41 weeks, the Group II - 28-34 weeks, the Group III - 22-27 weeks. Results. In the Group III prematures, blood clotting time (257.1±87.29ʺ) is longer than that of the Group I - 43.3±21.48ʺ and the Group II - 52.5±25.03ʺ. Angle α is larger in the Group I and the Group II - 47.6±12.49; 79.9±4.62; 76.7±4.84 (degrees). Amplitudes of contraction (5, 10 min, maximum) of the Group II are lower than the Group I by 10-22%. In the Group III, the amplitudes correlate with the concentration of fibrinogen up to 2 g/l - 4.6±1.39; 8.0±3.00; 7.9±5.56 (mm). The smallest lysis in the Group III (1.8±2.38%) versus the Group I and the Group II (17.1±2.34%, 8.1±2.50%. Maternal indicators of the amplitude of the coagulation are higher at a shorter gestational age. Conclusions. Maternal indicators of the amplitude of coagulation exceed the indicators of newborns by 1.5-2 times - 18.8±7.89 versus 17.4±7.04; 22.0±3.34 vs. 15.2±11.37 and 20.8±9.22 vs. 7.9±5.56 (mm). Blood clotting time of extremely premature newborns (257.1±87.29ʺ s) is longer than that of full-term and moderately premature infants (43.3±21.48ʺ; 52.5±25.03ʺ). Amplitudes of contractions of newborns of the Group III at the 5th minute are three times smaller, and at the 10th minute they are twice as small as in the Group I and the Group II - 4.6±1.39; 13.2±3.34; 16.2±5.38 (mm) and 8.0±3.01; 15.5±4.34; 16.0±7.39 (mm). In the Group III, coagulation lysis is minimal (1.8±2.38% vs. 17.1±2.34%; 8.1±2.50%). The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflict of interest.

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Basic Principles of Rotational Thromboelastometry (ROTEM®) and the Role of ROTEM—Guided Fibrinogen Replacement Therapy in the Management of Coagulopathies

Cited by 10 publications

References 52 publications

Comparison of Two Viscoelastic Testing Devices in a Parturient Population

Comparison of Two Viscoelastic Testing Devices in a Parturient Population

Liver Diseases: Science, Fiction and the Foreseeable Future

Indicators of rotational thromboelastometry in preterm delivery

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