Principles and Practice of Thromboelastography in Clinical Coagulation Management and Transfusion Practice

Bolliger, Daniel; Seeberger, Manfred D.; Tanaka, Kenichi A.

doi:10.1016/j.tmrv.2011.07.005

Cited by 347 publications

(330 citation statements)

References 103 publications

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“…The nature of the clot structure also depends on a complex interplay of entropic and enthalpic mechanisms accompanying structural changes and that underpin the nonlinear mechanical response in fibrin networks undergoing compressive deformation. 378 On simple kinetic grounds alone, changes in the fibrinogen concentration might be expected to have significant effects on the nature of the clot, and this is indeed observed, 34,113,126,238,292,379 with, for instance, higher fibrinogen concentrations leading to faster clotting times and hence 148 smaller clot pores. 149,380,381 In addition to changes in fibrinogen levels, one might suppose that changes in the fibrinogen molecule itself would have substantial effects, and this too is found.…”

Section: Effects Of Fibrinogen Concentration On the Nature Of The Clotmentioning

confidence: 98%

“…We show how this provides insight into hypofibrinolysis associated with inflammation (6) and how fibrinogen packaging (7) is changed during inflammation. Here we also discuss various substances and molecules (8) that may influence clot structure and also the relationship between hypercoagulability and fibrosis (9 106,109,[112][113][114][120][121][122][123][124] to the effect that results can be reasonably comparable in some circumstances but for detailed studies of specific effects it is probably wise to standardise on a particular instrument or technique.…”

Section: Relationship Between Chronic Inflammation and Hypercoagulabimentioning

confidence: 99%

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The simultaneous occurrence of both hypercoagulability and hypofibrinolysis in blood and serum during systemic inflammation, and the roles of iron and fibrin(ogen)

Kell

Pretorius

2014

Integrative Biology

127

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Although the two phenomena are usually studied separately, we summarise a considerable body of literature to the effect that a great many diseases involve (or are accompanied by) both an increased tendency for blood to clot (hypercoagulability) and the resistance of the clots so formed (hypofibrinolysis) to the typical, 'healthy' or physiological lysis. We concentrate here on the terminal stages of fibrin formation from fibrinogen, as catalysed by thrombin. Hypercoagulability goes hand in hand with inflammation, and is strongly influenced by the fibrinogen concentration (and vice versa); this can be mediated via interleukin-6. Poorly liganded iron is a significant feature of inflammatory diseases, and hypofibrinolysis may change as a result of changes in the structure and morphology of the clot, which may be mimicked in vitro, and may be caused in vivo, by the presence of unliganded iron interacting with fibrin(ogen) during clot formation. Many of these phenomena are probably caused by electrostatic changes in the iron-fibrinogen system, though hydroxyl radical (OH ) formation can also contribute under both acute and (more especially) chronic conditions. Many substances are known to affect the nature of fibrin polymerised from fibrinogen, such that this might be seen as a kind of bellwether for human or plasma health. Overall, our analysis demonstrates the commonalities underpinning a variety of pathologies as seen in both hypercoagulability and hypofibrinolysis, and offers opportunities for both diagnostics and therapies.

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Section: Effects Of Fibrinogen Concentration On the Nature Of The Clotmentioning

confidence: 98%

Section: Relationship Between Chronic Inflammation and Hypercoagulabimentioning

confidence: 99%

The simultaneous occurrence of both hypercoagulability and hypofibrinolysis in blood and serum during systemic inflammation, and the roles of iron and fibrin(ogen)

Kell

Pretorius

2014

Integrative Biology

127

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“…It is a medical device that is currently used in clinical practice [29][30][31]. The ROTEM uses a fixed cuvette (Cup) with a cylindrical pin that is immersed into the cup filled with whole blood (gap of 1 mm).…”

Section: Discussionmentioning

confidence: 99%

Dynamic and Quantitative Assessment of Blood Coagulation Status with an Oscillatory Rheometer

et al. 2018

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During open heart surgery, the haemostasis status of a patient has to be monitored permanently in order to quickly and reliably detect bleeding or coagulation-based disorders. Currently, no single medical device is available to provide a comprehensive solution for monitoring the coagulation status (coagulation, platelets and fibrinolysis). We intend to approach this problem with a rheological method. Here, we compared the performance of an oscillatory rheometer with a medical reference device, a ball coagulometer. Measuring the extrinsic coagulation (prothrombin time; PT), various heparin concentrations (0.5-2.0 IU/mL) could be differentiated and also discriminated from the intrinsic coagulation (activated partial thromboplastin time; aPTT) providing comparable clotting times between rheometer and ball coagulometer. In addition, the oscillatory rheometer was capable to detect the antagonising of heparin with the equimolar concentration of protamine and also the titration of various protamine concentrations (0.5-3.0 IU/mL) to a fixed heparin concentration (2 IU/mL). The addition of increasing concentrations of heparin to citrated blood prolonged the clotting time (CT), changed the slope calculated by linear regression of the elastic and viscous shear moduli (i.e., information of the coagulation process) and changed the value of the shear moduli at the end of the measurement (300 s). These results indicate that the oscillatory rheometer is capable to dynamically measure the haemostasis status with different activators and various inhibitor concentrations.

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“…It evaluates global hemostasis, though there have been conflicting reports on its reliability in different studies. 49 It has been shown to be a significantly better predictor of post-operative bleeding than the coagulation profile. 50 The INR liver is a modification of the standard INR where PT is calibrated using plasma from patients with cirrhosis instead of vitamin K antagonists and is thought to resolve variability of INR in these patients.…”

Section: Hemostasismentioning

confidence: 99%

Surgery in a Patient with Liver Disease

Rai

Nagral

2012

Journal of Clinical and Experimental Hepatology

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Surgery is often needed in patients with concurrent liver disease. The multiple physiological roles of the liver places these patients at an increased risk of morbidity and mortality. Diseases necessitating surgery like gallstones and hernia are more common in patients with cirrhosis. Assessment of severity of liver dysfunction before surgery is important and the risk benefit of the procedure needs to be carefully assessed. The disease severity may vary from mild transaminase rise to decompensated cirrhosis. Surgery should be avoided if possible in the emergency setting, in the setting of acute and alcoholic hepatitis, in a patient of cirrhosis who is child class C or has a MELD score more than 15 or any patient with significant extrahepatic organ dysfunction. In this subset of patients, all possible means to manage these patients conservatively should be attempted. Modified Child-Pugh scores and model for end-stage liver disease (MELD) scores can predict mortality after surgery fairly reliably including nonhepatic abdominal surgery. Pre-operative optimization would include control of ascites, correction of electrolyte imbalance, improving renal dysfunction, cardiorespiratory assessment, and correction of coagulation. Tests of global hemostasis like thromboelastography and thrombin generation time may be more predictive of the risk of bleeding compared with the conventional tests of coagulation in patients with cirrhosis. Correction of international normalized ratio with fresh frozen plasma does not necessarily mean reduction of bleeding risk and may increase the risk of volume overload and lung injury. International normalized ratio liver may better reflect the coagulation status. Recombinant factor VIIa in patients with cirrhosis needing surgery needs further study. Intra-operatively, safe anesthetic agents like isoflurane and propofol with avoidance of hypotension are advised. In general, nonsteroidal anti-inflammatory drug (NSAIDs) and benzodiazepines should not be used. Intra-abdominal surgery in a patient with cirrhosis becomes more challenging in the presence of ascites, portal hypertension, and hepatomegaly. Uncontrolled hemorrhage due to coagulopathy and portal hypertension, sepsis, renal dysfunction, and worsening of liver failure contribute to the morbidity and mortality in these patients. Steps to reduce ascitic leaks and infections need to be taken. Any patient with cirrhosis undergoing major surgery should be referred to a specialist center with experience in managing liver disease. ( J CLIN EXP HEPATOL 2012;2:238-246)

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Principles and Practice of Thromboelastography in Clinical Coagulation Management and Transfusion Practice

Cited by 347 publications

References 103 publications

The simultaneous occurrence of both hypercoagulability and hypofibrinolysis in blood and serum during systemic inflammation, and the roles of iron and fibrin(ogen)

The simultaneous occurrence of both hypercoagulability and hypofibrinolysis in blood and serum during systemic inflammation, and the roles of iron and fibrin(ogen)

Dynamic and Quantitative Assessment of Blood Coagulation Status with an Oscillatory Rheometer

Surgery in a Patient with Liver Disease

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