Management of Severe Bleeding in Cardiovascular Patients

Thromboelastography and Thromboelastometry in Assessment of Fibrinogen Deficiency and Prediction for Transfusion Requirement: A Descriptive Review

“…Thromboelastography (TEG; Haemonetics Corporation, Haemoscope Division, Nile, Illinois, USA) and Rotational Thromboelastometry (ROTEM; Tem Innovations GmbH, Munich, Germany; succeeded by Instrumentation Laboratory, Bedford, MA, USA) are two point-of-care systems for hemostatic tests in whole blood [7]. Both have been increasingly used to diagnose fibrinogen deficiency [8], predict risk of bleeding and mortality, and guide fibrinogen transfusion in trauma [9], cardiac surgery [10], liver transplantation [11], and postpartum bleeding [12]. TEG- and ROTEM-based algorithms have been widely used to direct fibrinogen administration in different settings leading to reduction in transfusion needs, costs, adverse outcomes, and even mortality [13–16] although a recent review indicated that the benefit of reduced blood products (red blood cells, fresh frozen plasma, and platelet) and improved morbidity in bleeding patients with the application of TEG- or ROTEM-guided transfusion strategies were primarily based on trials of elective cardiac surgery involving cardiopulmonary bypass, with low-quality evidence [17].…”

“…Although the role of TEG and ROTEM in diagnosis of coagulopathy, prediction of transfusion and mortality in bleeding patients has been reviewed [12, 29]. This paper is focused on the studies on TEG and ROTEM functional fibrinogen tests: FF TEG and ROTEM FIBTEM for the diagnosis of fibrinogen deficiency and prediction of transfusion requirements in bleeding patients.…”