Use of abciximab-Modified Thrombelastography in Patients Undergoing Cardiac Surgery

Kettner, Stephan C.; Panzer, Oliver; Kozek, Sibylle A.; Seibt, F; Stoiser, Brigitte; Kofler, Julia; Locker, Gottfried J.; Zimpfer, Michael

doi:10.1097/00000539-199909000-00007

Cited by 45 publications

(44 citation statements)

References 12 publications

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“…hypercoagulable). Many other reports have been published [11,29,31,32] since the first report of a correlation between MCF and fibrinogen in the normal population, and between MCF and both platelet count and fibrinogen concentration in a hypercoagulable population [33]. The association between MCF and both platelet count and fibrinogen concentration was confirmed in 1985 [11].…”

Section: Discussionmentioning

confidence: 86%

“…For example, CA 15 -EXTEM correlated with both PT and fibrinogen, whereas CA 10 -FIBTEM correlated with fibrinogen and CFT-INTEM with APTT. In trauma, Schreiber et al [29] suggested correlations between TEG Ò parameters and APTT (r-time) or platelets (MA), whereas in cardiac surgery, Kettner et al [32] found a correlation between fibrinogen and MA. Vorweg et al [22] proposed that CFT-INTEM could guide platelet transfusion.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography

Rugeri¹,

Levrat

David

et al. 2007

Journal of Thrombosis and Haemostasis

441

330

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Summary. Background: Reagent-supported thromboelastometry with the rotation thrombelastography (e.g. ROTEM Ò ) is a whole blood assay that evaluates the visco-elastic properties during blood clot formation and clot lysis. A hemostatic monitor capable of rapid and accurate detection of clinical coagulopathy within the resuscitation room could improve management of bleeding after trauma. Objectives: The goals of this study were to establish whether ROTEM correlated with standard coagulation parameters to rapidly detect bleeding disorders and whether it can help to guide transfusion. Methods: Ninety trauma patients were included in the study. At admission, standard coagulation assays were performed and ROTEM parameters such as clot formation time (CFT) and clot amplitude (CA) were obtained at 15 min (CA 15 ) with two activated tests (INTEM, EXTEM) and at 10 min (CA 10 ) with a test analyzing specifically the fibrin component of coagulation (FIBTEM). Results: Trauma induced significant modifications of coagulation as assessed by standard assays and ROTEM. A significant correlation was found between prothrombin time (PT) and CA 15 -EXTEM (r ¼ 0.66, P < 0.0001), between activated partial thromboplastin time and CFT-INTEM (r ¼ 0.91, P < 0.0001), between fibrinogen level and CA 10 -FIB-TEM (r ¼ 0.85, P < 0.0001), and between platelet count and CA 15 -INTEM (r ¼ 0.57, P < 0.0001). A cutoff value of CA 15 -EXTEM at 32 mm and CA 10 -FIBTEM at 5 mm presented a good sensitivity (87% and 91%) and specificity (100% and 85%) to detect a PT > 1.5 of control value and a fibrinogen less than 1 g L )1, respectively. Conclusions: ROTEM is a point-ofcare device that rapidly detects systemic changes of in vivo coagulation in trauma patients, and it might be a helpful device in guiding transfusion.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography

Rugeri¹,

Levrat

David

et al. 2007

Journal of Thrombosis and Haemostasis

441

330

View full text Add to dashboard Cite

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“…It is possible that with greater pack years of cigarette exposure, the baseline inflammatory and procoagulant markers would have been elevated, leading to significant differences between nonsmoking and presmoking samples. (2) In the present study, abciximab was used in a method as reported by Kettner et al, 21 to identify the contribution of fibrin to overall clot dynamics. Platelets treated with abciximab may still support thrombin generation.…”

Section: Cse Increases the Risk For Arterial Thrombosis And In The Comentioning

confidence: 99%

Effects of Cigarette Smoke Exposure on Clot Dynamics and Fibrin Structure

Barua

Srikanth

et al. 2010

ATVB

115

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Objectives-The purpose of this study was to examine the effect of cigarette smoke exposure (CSE) on clot dynamics and fibrin architecture and to isolate the relative contribution of platelets and fibrinogen to clot dynamics. Methods and Results-From young healthy males smokers (nϭ34) and nonsmokers (nϭ34) a baseline blood was drawn, and smokers had another blood draw after smoking 2 regular cigarettes. Using thromboelastography (TEG) the degree of platelet-fibrin interaction was measured. In additional experiments, abciximab (20 g/mL) was added to the smokers samples (nϭ27) to reduce the effects of platelet function from the TEG parameters. The maximum clot strength (G) obtained with abciximab measured mainly the contribution of fibrinogen to clot strength (GF). By subtracting GF from G, the contribution of platelets to clot strength (GP) was presumed. A significant difference was found for all TEG parameters between nonsmokers versus postsmoking and pre-versus postsmoking samples. Postsmoking both GF and GP were significantly higher as compared to presmoking. On electron microscopy and turbidity analysis, postsmoking fibrin clots were significantly different compared to presmoking and nonsmoking samples. Conclusions-Acute CSE changes clot dynamics and alters fibrin architecture. Both functional changes in fibrinogen and platelets appear to contribute to heightened thrombogenicity after acute CSE.

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“…Abciximab is a potent platelet glycoprotein (Gp)IIb/IIIa inhibitor and an abciximabmodified TEG Ò can help to discriminate between hypofibrinogenaemia and platelet dysfunction as a cause of decreased MA (Kettner et al, 1999). Fibrinolysis.…”

Section: Poct: Thrombelastography (Te)mentioning

confidence: 99%

Point‐of‐care testing in haemostasis

Perry

Fitzmaurice

Kitchen³

et al. 2010

Br J Haematol

125

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SummaryPoint-of-care testing (POCT) in haematology has seen a significant increase in both the spectrum of tests available and the number of tests performed annually. POCT is frequently undertaken with the belief that this will reduce the turnaround time for results and so improve patient care. The most obvious example of POCT in haemostasis is the out-ofhospital monitoring of the International Normalized Ratio in patients receiving a vitamin K antagonist, such as warfarin. Other areas include the use of the Activated Clotting Time to monitor anticoagulation for patients on cardio-pulmonary bypass, platelet function testing to identify patients with apparent aspirin or clopidogrel resistance and thrombelastography to guide blood product replacement during cardiac and hepatic surgery. In contrast to laboratory testing, POCT is frequently undertaken by untrained or semi-trained individuals and in many cases is not subject to the same strict quality control programmes that exist in the central laboratory. Although external quality assessment programmes do exist for some POCT assays these are still relatively few. The use of POCT in haematology, particularly in the field of haemostasis, is likely to expand and it is important that systems are in place to ensure that the generated results are accurate and precise.Keywords: point-of-care testing, haemostasis, quality assurance, near patient testing.Point-of-care testing (POCT) is defined as a diagnostic test at or near the site of the patient with the rationale that such testing will result in the rapid generation of results and improve patient care. POCT is frequently undertaken by nonlaboratory personnel both within and outwith the hospital setting and the last 10 years has seen a significant increase in its use, particularly in the field of haemostasis. The importance of POCT is highlighted by a recent publication from the This review summarizes POCT in relation to haemostasis, and complements a previously published guideline by the British Committee for Standards in Haematology on POCT in Haematology (Briggs et al, 2008).

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Use of abciximab-Modified Thrombelastography in Patients Undergoing Cardiac Surgery

Cited by 45 publications

References 12 publications

Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography

Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography

Effects of Cigarette Smoke Exposure on Clot Dynamics and Fibrin Structure

Point‐of‐care testing in haemostasis

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