Clinical Utility of Thromboelastography: One Size Does Not Fit All

Wegner, Julie; Popovsky, Mark

doi:10.1055/s-0030-1265286

Cited by 51 publications

(45 citation statements)

References 109 publications

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“…There was a clear advantage for ROTEM as compared to standard coagulation test concerning extensively shorter turnaround times, which will have impact on a timely and more targeted coagulation therapy [30][31][32].…”

Section: Management Of Dilutional Coagulopathy In Childrenmentioning

confidence: 99%

Management of Dilutional Coagulopathy during Pediatric Major Surgery

Haas¹,

Mauch²,

Weiß³

et al. 2012

Transfus Med Hemother

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Perioperative dilutional coagulopathy is a major coagulation disorder during adult and pediatric surgery. Although the main underlying mechanisms are comparable, data of the development and management of dilutional coagulopathy in children are scarce. Observational data showed that intraoperative coagulation disorders mainly based on complex disturbances of clot firmness including acquired fibrinogen as well as factor XIII deficiencies, while clotting time and platelet counts remained fairly stable. A fast and reliable monitoring of the entire coagulation process (e.g. thrombelastometry) might be of extreme value for detection and guidance of effective coagulation management. Although the transfusion of fresh frozen plasma was recommended in several guidelines, the use of coagulation factors might offer an alternative and potentially superior approach in managing perioperative coagulation disorders. Further studies are urgently needed to determine the efficacy of modern coagulation management.

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Section: Management Of Dilutional Coagulopathy In Childrenmentioning

confidence: 99%

Management of Dilutional Coagulopathy during Pediatric Major Surgery

Haas¹,

Mauch²,

Weiß³

et al. 2012

Transfus Med Hemother

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“…Second, we did not concurrently examine standard coagulation parameters in parallel with TEG. Prior studies have demonstrated that TEG out-performs traditional laboratory testing for coagulation abnormalities [19,41], TEG better predicts outcomes compared to traditional tests [8,20], and TEG may be more cost-effective [42]. Therefore, we did not feel that further comparison with standard coagulation parameters was necessary.…”

Section: Discussionmentioning

confidence: 98%

Thromboelastography Defines Late Hypercoagulability After TBI: A Pilot Study

et al. 2014

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“…In addition, TEG may help document the prothrombotic state that sometimes occurs in post liver transplant patients because of deficiencies in antithrombin Ⅲ and protein C causing potentially disastrous hepatic artery thrombosis [56] . Even though the usefulness of TEG in complex coagulation defects has been questioned [57] , recent literature does reaffirm that the use of TEG and rotation thromboelastometry in more rational transfusion algorithms can reduce the number of blood products transfused [58] .…”

Section: Thromboelastographymentioning

confidence: 99%

Blood loss, predictors of bleeding, transfusion practice and strategies of blood cell salvaging during liver transplantation

Feltracco¹

2013

WJH

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Blood loss during liver transplantation (OLTx) is a common consequence of pre-existing abnormalities of the hemostatic system, portal hypertension with multiple collateral vessels, portal vein thrombosis, previous abdominal surgery, splenomegaly, and poor "functional" recovery of the new liver. The intrinsic coagulopathic features of end stage cirrhosis along with surgical technical difficulties make transfusion-free liver transplantation a major challenge, and, despite the improvements in understanding of intraoperative coagulation profiles and strategies to control blood loss, the requirements for blood or blood products remains high. The impact of blood transfusion has been shown to be significant and independent of other well-known predictors of posttransplant-outcome. Negative effects on immunomodulation and an increased risk of postoperative complications and mortality have been repeatedly demonstrated. Isovolemic hemodilution, the extensive utilization of thromboelastogram and the use of autotransfusion devices are among the commonly adopted procedures to limit the amount of blood transfusion. The use of intraoperative blood salvage and autologous blood transfusion should still be considered an important method to reduce the need for allogenic blood and the associated complications. In this article we report on the common preoperative and intraoperative factors contributing to blood loss, intraoperative transfusion practices, anesthesiologic and surgical strategies to prevent blood loss, and on intraoperative blood salvaging techniques and autologous blood transfusion. Even though the advances in surgical technique and anesthetic management, as well as a better understanding of the risk factors, have resulted in a steady decrease in intraoperative bleeding, most patients still bleed extensively. Blood transfusion therapy is still a critical feature during OLTx and various studies have shown a large variability in the use of blood products among different centers and even among individual anesthesiologists within the same center. Unfortunately, despite the large number of OLTx performed each year, there is still paucity of large randomized, multicentre, and controlled studies which indicate how to prevent bleeding, the transfusion needs and thresholds, and the "evidence based" perioperative strategies to reduce the amount of transfusion.

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Clinical Utility of Thromboelastography: One Size Does Not Fit All

Cited by 51 publications

References 109 publications

Management of Dilutional Coagulopathy during Pediatric Major Surgery

Management of Dilutional Coagulopathy during Pediatric Major Surgery

Thromboelastography Defines Late Hypercoagulability After TBI: A Pilot Study

Blood loss, predictors of bleeding, transfusion practice and strategies of blood cell salvaging during liver transplantation

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