Sonorheometry versus rotational thromboelastometry in trauma: a comparison of diagnostic and prognostic performance

Rossetto, Andrea; Wohlgemut, Jared M; Brohi, Karim; Davenport, Ross

doi:10.1016/j.jtha.2023.04.031

Cited by 3 publications

(1 citation statement)

References 44 publications

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“…The QStat ® cartridge allows for the exploration of clotting time (CT), clot stiffness (CS), fibrinogen and platelet contribution to clot stiffness (FCS and PCS) and clot stability to lysis (CSL) [9]. In trauma, and in orthopaedic and cardiac surgery, Quantra ® results were well correlated with VET results and standard laboratory results [9][10][11][12][13]. Moreover, in high bleeding-risk cardiac surgery, a Quantra ® -guided transfusion algorithm was associated with a decrease in transfusion and major bleeding compared to a laboratory-based transfusion algorithm [14].…”

Section: Introductionmentioning

confidence: 99%

Sonorheometry Device Thresholds in Liver Transplantation: An Observational Retrospective Study

Soucy-Proulx,

Kato,

Coeckelenbergh

et al. 2024

JCM

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Background: Liver transplantation (LT) remains a potentially haemorrhagic procedure whose perioperative bleeding and transfusion could be better monitored using point-of-care devices. Quantra® is a device based on sonorheometry to assess whole blood clot formation. Our aims were to describe Quantra® parameters during LT and to study their correlations with standard laboratory parameters, and to determine Quantra® cut-off values for thrombocytopenia, hypofibrinogenemia and coagulation factors’ deficit. Methods: In 34 patients undergoing LT, blood samples were collected before surgical incision, 15 min after the beginning of the anhepatic phase, and 15 min after arterial revascularization of the graft. Results: Clotting time (CT) was well correlated with prothrombin (PT) ratio and activated partial thromboplastin time (aPTT) ratio. Platelet contribution to clot stiffness (PCS) was correlated with platelets (ρ = 0.82, p < 0.001) and fibrinogen contribution clot stiffness (FCS) with fibrinogen (Fg) (ρ = 0.74, p < 0.001). CT predicted a PT ratio < 30% with an area under the curve (AUC) of 0.93 (95% CI 0.87–0.98; p < 0.001). PCS predicted a platelet count < 50 G/L with an AUC of 0.87 (95% CI 0.76–0.98, p < 0.001). FCS predicted a Fg < 1.0, 1.2 or 1.5 g/L, with an AUC of 0.86 (95% CI 0.77–094, p < 0.001), 0.82 (95% CI 0.74–0.91, p < 0.001) and 0.88 (95% CI 0.82–0.95, p < 0.001), respectively. Conclusion: Quantra® provides a rapid assessment of haemostasis during LT.

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Section: Introductionmentioning

confidence: 99%

Sonorheometry Device Thresholds in Liver Transplantation: An Observational Retrospective Study

Soucy-Proulx,

Kato,

Coeckelenbergh

et al. 2024

JCM

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Point-of-care, goal-directed management of bleeding in trauma patients

Zipperle,

Schmitt,

Schöchl

2023

Current Opinion in Critical Care

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Purpose of the review The purpose of this review is to consider the clinical value of point-of-care (POC) testing in coagulopathic trauma patients with traumatic brain injury (TBI) and trauma-induced coagulopathy (TIC). Recent findings Patients suffering from severe TBI or TIC are at risk of developing pronounced haemostatic disorders. Standard coagulation tests (SCTs) are insufficient to reflect the complexity of these coagulopathies. Recent evidence has shown that viscoelastic tests (VETs) identify haemostatic disorders more rapidly and in more detail than SCTs. Moreover, VET results can guide coagulation therapy, allowing individualised treatment, which decreases transfusion requirements. However, the impact of VET on mortality remains uncertain. In contrast to VETs, the clinical impact of POC platelet function testing is still unproven. Summary POC SCTs are not able to characterise the complexity of trauma-associated coagulopathy. VETs provide a rapid estimation of underlying haemostatic disorders, thereby providing guidance for haemostatic therapy, which impacts allogenic blood transfusion requirements. The value of POC platelet function testing to identify platelet dysfunction and guide platelet transfusion is still uncertain.

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Massive Transfusion/Hemorrhage Protocols Versus Goal-Directed Bleeding Management: Science Gone Eerie?

Görlinger,

Kapoor

2024

JCCC

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Key questions in bleeding management are “Why does my patient bleed?” and “How to fix it?” To answer the first question, the high negative predictive value of viscoelastic testing can be used to identify coagulopathic bleeding. Accordingly, goal-directed bleeding management (GDBM) guided by viscoelastic testing has been shown to be an effective and essential part of the second pillar of patient blood management (PBM) with the aim to improve patients’ outcomes and safety. Patient’s medical and drug history – with a focus on medication with oral anticoagulants and antiplatelet drugs – are important in emergency, urgent, and elective surgery. Furthermore, risk scores have been developed and validated for traumatic and obstetric hemorrhage and can be helpful tools to predict severe hemorrhage and the need for massive transfusion. Acidosis, hypocalcemia, anemia, and hypothermia (“diamond of death in trauma”) are important basic conditions for hemostasis and good predictors of coagulopathy and should be closely monitored by blood gas analysis and corrected in bleeding patients. Earlier time to hemostasis was associated with decreased mortality in trauma studies. Therefore, GDBM aims to stop the bleeding as soon as possible and avoid the main killers in blood transfusion: Transfusion-associated circulatory overload, transfusion-related acute lung injury, transfusion-related immune modulation, and thrombosis. Thromboelastometry-guided bleeding management follows the concepts of Good Medical Practice and Precision Medicine. Here, rotational thromboelastometry (ROTEM)-guided bleeding management algorithms are using a stepwise approach based on the sequence “Treat first what kills first:” (1) Fibrinolysis management, (2) clot firmness management, (3) thrombin generation management, and (4) avoidance of hypercoagulability and thrombosis. Here, thromboelastometry can not only identify patients with hypercoagulability and increased risk of thrombosis but also ROTEM-guided bleeding management can avoid thromboembolic complications, too. This may support the idea of personalized antithrombotic therapy guided by viscoelastic testing in the postoperative period. Finally, PBM is not about blood transfusion: It is about patients’ outcomes. Accordingly, several meta-analyses based on more than 20 randomized controlled trials on the effect of viscoelastic testing-guided perioperative bleeding management did not only demonstrate a significant reduction in transfusion requirements but also a significant reduction in mortality and postoperative acute kidney injury. The reduction in postoperative acute kidney injury again has a significant impact on long-term survival. Accordingly, recent PBM guidelines recommend the implementation of viscoelastic testing-guided bleeding management algorithms with a 1B or 1A recommendation. This is also addressed in the World Health Organization policy brief about the urgent need to implement PBM in all member states in a timely manner. However, even if the number of national activities is increasing, there is still a long way to go.

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Sonorheometry versus rotational thromboelastometry in trauma: a comparison of diagnostic and prognostic performance

Cited by 3 publications

References 44 publications

Sonorheometry Device Thresholds in Liver Transplantation: An Observational Retrospective Study

Sonorheometry Device Thresholds in Liver Transplantation: An Observational Retrospective Study

Point-of-care, goal-directed management of bleeding in trauma patients

Massive Transfusion/Hemorrhage Protocols Versus Goal-Directed Bleeding Management: Science Gone Eerie?

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