Cost reduction of perioperative coagulation management in cardiac surgery: value of ‘bedside’ thrombelastography (ROTEM)☆

Spalding, G; Hartrumpf, Martin; Sierig, T.; Oesberg, N.; Kirschke, C. G.; Albes, Johannes M.

doi:10.1016/j.ejcts.2007.02.022

Cited by 190 publications

(149 citation statements)

References 24 publications

(28 reference statements)

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“…The value of ROTEM has also been reported for cardiac surgery and liver transplantations 6,7,17 , where it is particularly important to be able to monitor the coagulation in real time. Unfortunately, such real-time monitoring is not feasible with standard laboratory coagulation tests.…”

Section: Discussionmentioning

confidence: 99%

Bedside assessment of fibrinogen level in postpartum haemorrhage by thrombelastometry

Huissoud

Carrabin

Audibert

et al. 2009

BJOG

207

161

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Objectives To establish whether reagent-supported thrombelastometry with the rotation thrombelastometry system (ROTEM Ò ) point-of-care device correlated with fibrinogen level in postpartum haemorrhages.Design Prospective observational study.Population and setting Ninety-one women at the third trimester of pregnancy: 37 with postpartum haemorrhage (study group) and 54 without abnormal bleeding (control group).Methods Standard laboratory test results were compared with those obtained at bedside from the ROTEM with the FIBTEM Ò test (54 tests in the control group and 51 in the study group). Results Median fibrinogen level was significantly lower in the haemorrhage group than in the control group (3.4 and 5.1 g/l, respectively, P < 0.0001). Median CT was higher in the haemorrhage group than in the control group (P = 0.05). CA 5 , CA 15 and MCF were significantly lower in the haemorrhage group than in controls (P < 0.0001) and strongly correlated with fibrinogen levels in both groups (r = 0.84-0.87, P < 0.0001). A cut-off value of CA 5 at 5 mm and CA 15 at 6 mm presented an excellent sensitivity (100% for both parameters) and a good specificity (respectively 85 and 88%) to detect fibrinogen levels <1.5 g/l in postpartum haemorrhage.Conclusions The early parameters obtained from the FIBTEM test correlated well with fibrinogen levels. ROTEM might be helpful in guiding fibrinogen transfusion during postpartum haemorrhage.

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Section: Discussionmentioning

confidence: 99%

Bedside assessment of fibrinogen level in postpartum haemorrhage by thrombelastometry

Huissoud

Carrabin

Audibert

et al. 2009

BJOG

207

161

View full text Add to dashboard Cite

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“…A number of retrospective studies have compared the costs of hemotherapy before and after the implementation of POC-based chemotherapeutic algorithms [43][44][45]. Most studies involved cardiothoracic surgery patients and produced conflicting results [43][44][45].…”

Section: Economic Aspectsmentioning

confidence: 99%

“…While Gorlinger et al showed fewer postoperative thrombotic/thromboembolic complications in the POC group compared to the control group, the groups did not differ with respect to perioperative mortality [43][44][45]. In fact, five prospective randomized trials with various lengths of postoperative follow-up have shown no beneficial effect of POC-based coagulation therapy on postoperative mortality [43][44][45]. The blood collection site, method of sampling processing, patient age, and patient gender may significantly affect the results of these tests [46].…”

Section: Limitations Of Pocmentioning

confidence: 99%

Perioperative coagulopathy monitoring

et al. 2013

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Coagulopathy is common in orthopedic surgery patients either due to acquired factors, such as surgery, trauma, medications, or hemorrhage. Perioperative monitoring of blood coagulation is critical to diagnose the causes of hemorrhage, guide hemostatic therapies, predict the risk of bleeding during surgical procedures, and reduce risk of postoperative cardiac and thromboembolic events. In contrast to previous interventions that measure specific portions of the clotting cascade (such as intrinsic or extrinsic pathways or platelet aggregation), ''Point-ofcare'' coagulation monitoring devices assess the viscoelastic properties of whole blood. These techniques have the potential to measure the entire clotting process, starting with fibrin formation, clot retraction, and fibrinolysis. Furthermore, the coagulation status of patients is assessed in whole blood, allowing the plasmatic coagulation system to interact with platelets and red cells, and thereby providing useful additional information on platelet function. Improved monitoring of coagulopathy is particularly important as new anticoagulant drugs emerge that affect the clotting cascade in novel ways, including the inhibition of intrinsic and extrinsic pathways and platelet function. It is important for orthopedic surgeons to understand the pharmacology and reversal of these drugs in the perioperative setting. The purpose of this review is to review the current techniques to monitoring perioperative coagulopathy and to identify the manner in which novel anticoagulant medications affect the clotting cascade with particular interest in trauma and spine surgery.

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“…Other reports have stated the use of different parameters provided by these tests are predictors of both postoperative bleeding and blood product use [143][144][145] . Thrombelastograph Platelet Mapping System has been developed to monitor antiplatelet therapy [146][147][148][149] .…”

Section: Viscoelastic Methodsmentioning

confidence: 99%

Assessment of platelet function: Laboratory and point-of-care methods

Paniccia¹

2014

WJTM

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In the event of blood vessel damage, human platelets are promptly recruited on the site of injury and, after their adhesion, activation and aggregation, prevent blood loss with the formation of a clot. The consequence of abnormal regulation can be either hemorrhage or the development of thrombosis. Qualitative and/or quantitative defects in platelets promote bleeding, whereas the residual reactivity of platelets, despite antiplatelet therapies, play an important role in promoting arterial thrombotic complications. Platelet function is traditionally assessed to investigate the origin of a bleeding syndrome, to predict the risk of bleeding prior surgery or during pregnancy or to monitor the efficacy of antiplatelet therapy in thrombotic syndromes that, now, can be considered a new discipline. "Old" platelet function laboratory tests such as the evaluation of bleeding time and the platelet aggregation analysis in platelet-rich plasma are traditionally utilized to aid in the diagnosis and management of patients with platelet and hemostatic disorders and used as diagnostic tools both in bleeding and thrombotic diathesis in specialized laboratories. Now, new and renewed automated systems have been introduced to provide a simple, rapid assessment of platelet function including point of care methods. These new methodologies are also suitable for being used in non-specialized laboratories and in critical area for assessing platelet function in whole blood without the requirement of sample processing. Some of these methods are also beginning to be incorporated into routine clinical use and can be utilized as not only as first panel for the diagnosis of platelet dysfunction, but also for monitoring anti-platelet therapy and to potentially assess risk of both bleeding and/or thrombosis.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Platelets; Method; Test; Point of care testing; Laboratory assessment; Bleeding; Thrombosis; Platelet function Core tip: This review discussed the scenario of available platelet function laboratory and point-of-care methods suitable in different clinical setting. As this matter has become of crucial importance in the bleeding management and for monitoring antiplatelet therapies, improved ability to assess platelet function in a timely and efficient manner is essential. Traditional platelet function methods, requiring a fair degree of expertise, have been limited to specialized laboratory. Many efforts have been carried out for improving platelet function assays for centralized laboratory, such as different point-of-care testing methodologies have been developed. Moreover, different guidelines and recommendations for their method standardization are growing.

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Cost reduction of perioperative coagulation management in cardiac surgery: value of ‘bedside’ thrombelastography (ROTEM)☆

Cited by 190 publications

References 24 publications

Bedside assessment of fibrinogen level in postpartum haemorrhage by thrombelastometry

Bedside assessment of fibrinogen level in postpartum haemorrhage by thrombelastometry

Perioperative coagulopathy monitoring

Assessment of platelet function: Laboratory and point-of-care methods

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