scholarly journals A new era of thromboelastometry

2017 ◽  
Vol 15 (3) ◽  
pp. 380-385 ◽  
Author(s):  
Tomaz Crochemore ◽  
Felipe Maia de Toledo Piza ◽  
Roseny dos Reis Rodrigues ◽  
João Carlos de Campos Guerra ◽  
Leonardo José Rolim Ferraz ◽  
...  
Keyword(s):  
Activated Partial Thromboplastin Time ◽  
Allogeneic Blood ◽  
Effective Control ◽  
Common Complication ◽  
Transfusion Therapy ◽  
Rotational Thromboelastometry ◽  
Goal Directed Therapy ◽  
New Era ◽  
Coagulation Tests ◽  
Severe Hemorrhage

ABSTRACT Severe hemorrhage with necessity of allogeneic blood transfusion is common complication in intensive care unit and is associated with increased morbidity and mortality. Prompt recognition and treatment of bleeding causes becomes essential for the effective control of hemorrhage, rationalizing the use of allogeneic blood components, and in this way, preventing an occurrence of their potential adverse effects. Conventional coagulation tests such as prothrombin time and activated partial thromboplastin time present limitations in predicting bleeding and guiding transfusion therapy in critically ill patients. Viscoelastic tests such as thromboelastography and rotational thromboelastometry allow rapid detection of coagulopathy and goal-directed therapy with specific hemostatic drugs. The new era of thromboelastometry relies on its efficacy, practicality, reproducibility and cost-effectiveness to establish itself as the main diagnostic tool and transfusion guide in patients with severe active bleeding.

scholarly journals Comparison of standard coagulation tests and rotational thromboelastometry for hemostatic system monitoring during orthotopic liver transplantation: Results from a pilot study

2015 ◽  
Vol 68 (9-10) ◽  
pp. 301-307 ◽  
Author(s):  
Sladjana Novakovic-Anucin ◽  
Dusica Kosanovic ◽  
Sanja Gnip ◽  
Visnja Canak ◽  
Velibor Cabarkapa ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Platelet Count ◽  
Fibrinogen Level ◽  
Activated Partial Thromboplastin Time ◽  
Coagulation Time ◽  
Rotational Thromboelastometry ◽  
Hemostatic System ◽  
Coagulation Tests ◽  
Clot Formation Time ◽  
Maximum Clot Firmness

Introduction. During liver transplantation, continuous laboratory monitoring of complex changes of the hemostatic system is necessary. The aim of this study was to compare two methods of monitoring: standard coagulation tests and rotational thromboelastometry. Material and Methods. The study included 17 patients who had undergone orthotopic liver transplantation in the Clinical Centre of Vojvodina, Serbia in the period from June 2008 to October 2012. The coagulation parameters (platelet count, activated partial thromboplastin time, prothrombin time and fibrinogen level) were compared with the thromboelastometric parameters (coagulation time, clot formation time and maximal clot firmness). Results. The results showed a statistically significant correlation between the platelet count and maximum clot firmness of the intrinsically (r=0.51, p<0.001) and extrinsically activated thromboelastometric assays (r=0.64, p<0.001). The fibrinogen level and maximum clot firmness of the fibrinogen thromboelastometric test correlated significantly as well (r=0.44, p=0.002). No significant correlations were found among the activated partial thromboplastin time, prothrombin time, coagulation time and clot formation time. Conclusion. For an adequate perioperative monitoring of the dynamic intraoperative hemostatic changes and the optimal use of blood derivatives during liver transplantation, the combined application of standard coagulation tests and rotational thromboelastometry should be considered whenever possible. Science and Technological Development, Republic of Serbia

scholarly journals Rotational Thromboelastometry (ROTEM) for Assessing the Anticoagulant Effect of Rivaroxaban: A Single-Centre Cohort Study

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5018-5018
Author(s):  
Thomas Andrew Fox ◽  
Andrew Wood ◽  
Anne Riddell ◽  
Pratima Chowdary ◽  
Anja B Drebes
Keyword(s):  
Creatinine Clearance ◽  
Prothrombin Time ◽  
Board Of Directors ◽  
Partial Thromboplastin Time ◽  
Research Funding ◽  
Activated Partial Thromboplastin Time ◽  
Anticoagulant Effect ◽  
Advisory Committees ◽  
Rotational Thromboelastometry ◽  
Coagulation Tests

Abstract Background: The direct, oral, factor Xa inhibitor, rivaroxaban, is increasingly used to provide effective anticoagulation in atrial fibrillation and venous thromboembolism. Whilst rivaroxaban does not require therapeutic monitoring there are situations when it is useful to estimate the anticoagulant effect of the drug such as during bleeding episodes or before emergency surgery. It has previously been shown that conventional coagulation tests can provide a crude estimation of anticoagulant effect of rivaroxaban if a sensitive reagent is used. In this study we explore whether rotational thromboelastometry (ROTEM) would provide a more accurate measure of rivaroxaban effect. Methods: Peak serum rivaroxaban levels were taken 3-5 hours post-dose in 121 consecutive patients established on a once-daily anticoagulation regime with rivaroxaban. Conventional coagulation tests, prothrombin time (PT) and activated partial thromboplastin time (APTT) were performed alongside rivaroxaban level and rotational thromboelastometry (ROTEM, TEM Ltd, Germany) on native citrated whole blood. PT and APTT used HemosIL Recombiplastin 2G and SynthasIL reagents (Instrumentation Laboratory (IL), USA) respectively. Rivaroxaban levels were measured using HemosIL Liquid Anti Xa kit (IL, USA) with rivaroxaban calibrators from Hyphen Biomed, France on an ACL TOP 700 coagulometer (IL, USA)). Demographic and biochemical data was collected on each patient. Results were analysed to determine if ROTEM can be used to assess the anticoagulant effect of rivaroxaban in real-world patients with different demographics and organ function. Results: Significant positive correlation was seen between rivaroxaban level and prothrombin time (PT) (R=0.796, Pearson's correlation coefficient). Weaker correlation was observed between rivaroxaban level and activated partial thromboplastin time (APTT) (R=0.425). There was modest positive correlation between the clotting time (CT) parameter using ROTEM and rivaroxaban level (R=0.328). However, when grouped into low (<200ng/ml), intermediate (200-300ng/ml) and high (>300ng/ml) rivaroxaban levels, the CTs show no meaningful association and therefore cannot be used as a surrogate marker to predict anticoagulant effect. There is no significant difference between the mean rivaroxaban levels for patients on 15mg rivaroxaban, those on 20mg with creatinine clearance <60ml/min and those on 20mg with creatinine clearance >60ml/min (Analysis of Variance, n=121, F=2.009, P=0.159), suggesting that with dose adjustment a similar anticoagulant effect is achieved in patients with different renal function. Conclusion: Our data suggests that the correlation between rivaroxaban levels and ROTEM CT parameter is not sufficiently strong to reliably predict the anticoagulant effect of rivaroxaban and does not confer any advantage over conventional clotting tests. Disclosures Chowdary: Baxalta: Honoraria, Membership on an entity's Board of Directors or advisory committees; Biogen: Honoraria, Membership on an entity's Board of Directors or advisory committees; CSL Behring: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sobi: Honoraria; Bayer: Honoraria; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novo Nordisk: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Drebes:Bayer: Consultancy; Bayer: Other: Educational Grant.

scholarly journals Antenatal management of severe feto-maternal alloimmune thrombocytopenia: HLA incompatibility may affect responses to fetal platelet transfusions

Blood ◽  
1993 ◽  
Vol 81 (8) ◽  
pp. 2174-2179 ◽  
Author(s):  
MF Murphy ◽  
P Metcalfe ◽  
AH Waters ◽  
J Ord ◽  
H Hambley ◽  
...  
Keyword(s):  
Management Strategies ◽  
Successful Outcome ◽  
Normal Infant ◽  
Transfusion Therapy ◽  
Severe Hemorrhage ◽  
Antenatal Management ◽  
Alloimmune Thrombocytopenia ◽  
Maternal Administration ◽  
First Time ◽  
Platelet Transfusions

In feto-maternal alloimmune thrombocytopenia (FMAIT), severe hemorrhage, particularly intracranial haemorrhage (ICH), may occur before delivery. Management strategies to prevent ICH in high-risk pregnancies include maternal administration of intravenous Ig with or without steroids and fetal platelet transfusions. This report describes a patient who lost three fetuses with ICH because of FMAIT due to anti- HPA-1a. ICH occurred earlier in successive pregnancies (at 28, 19, and 16 weeks of gestation) despite maternal treatment with intravenous Ig and steroids from 14 weeks of gestation in the third pregnancy. The fourth pregnancy was managed by administering weekly intraperitoneal injections of Ig to the fetus from 12 to 18 weeks of gestation. At 18 weeks, there was no evidence of ICH, but the fetal platelet count was only 12 x 10(9)/L. Serial fetal platelet transfusions were started, but there were poor responses because of immune destruction of the transfused platelets by maternal HLA antibodies. There were improved responses to transfusions prepared from the mother and from HLA- compatible HPA-1a-negative donors. At 35 weeks of gestation, a normal infant was delivered by Caesarean section after 20 platelet transfusions. There was prolonged thrombocytopenia in the baby for 15 weeks after birth, probably due to transfer of HPA-1a antibodies in the transfusions of unwashed maternal platelets. The optimal management of pregnancies likely to be severely affected by FMAIT is still evolving. Intensive management was successful in this case, but a successful outcome cannot be guaranteed in severely affected cases. This is the first time that HLA incompatibility has been found to complicate fetal transfusion therapy.

scholarly journals Alteration of Coagulation in Intensively Transfused Hemophilic Patients

1977 ◽  
Author(s):  
Helen S. Hathaway ◽  
Roger D. Hamstra ◽  
Linda Jacobson ◽  
William E. Hathaway
Keyword(s):  
Factor Viii ◽  
Degradation Products ◽  
Bleeding Tendency ◽  
Transfusion Therapy ◽  
Coagulation Tests ◽  
Factor Viii Concentrates ◽  
The One ◽  
Altered Proteins ◽  
Dose Factor

Bleeding may occasionally occur in adequately transfused hemophilic patients. To investigate this phenomenon, 11 patients with classical hemophilia had serial coagulation studies performed during intensive transfusion therapy with factor VIII concentrates given for surgical procedures. The studies included kaolin partial thromboplastin times (KPTT), fibrinogen, monomer, and fibrin split products (FSP) levels, and assays for factor VIII by the one-stage PTT method (PTT-VIII), thromboplastin generation time method (TGT-VIII), and immunologic method (VIII Ag). After an initial correcting dose, factor VIII concentrates were administered once to twice daily in a dose to keep the minimal level above 20 percent. Alterations of coagulation assays were most pronounced 7–10 days postoperatively. These included (1) KPTT values at least 20 seconds longer than expected for the percent factor VIII;(2) TGT-VIII levels consistently higher than PTT-VIII levels (mean difference was 20 percent);(3) VIII Ag values from 216–660 percent of normal. Fibrin monomer and FSP tests were frequently positive and fibrinogen levels ranged from 300–700 mgm percent. Four patients exhibited spontaneous wound bleeding on postoperative days 7, 7, 9, and 12 in spite of adequate factor VIII levels. These studies and the results of in vitro experiments with factor VIII concentrates suggest that altered proteins or degradation products of fibrinogen or factor VIII may produce spurious values for coagulation tests and may be associated with an increased bleeding tendency and/or abnormal wound healing.

The Discussion on Countermeasures of Perfecting the Operating Cost Control and Strengthening the Hospital Financial Management

2020 ◽  
Vol 9 (4) ◽  
pp. 174
Author(s):  
Youhong Liu
Keyword(s):  
Financial Management ◽  
Medical Service ◽  
Cost Control ◽  
Operating Cost ◽  
Medical Industry ◽  
Operating Costs ◽  
Effective Control ◽  
New Era ◽  
Technical Requirements ◽  
Hospital Financial Management

At present, the medical industry has developed into a sunrise industry in the new era. With the continuous improvement of the level of medical services and technical requirements and the establishment and improvement of related medical service institutions, the competition between the medical industries is further intensified. As a complex, hospitals must achieve cost control and financial management in order to achieve ideal operating benefits. At present, there are still many problems in the financial management and cost control of related hospitals. For this, it is necessary to grasp the problem and take effective measures to cope with it, promoting the effective control of hospital operating costs, and achieving efficient financial management goals.

Can RoTEM®analysis be applied for haemostatic monitoring in paediatric congenital heart surgery?

2011 ◽  
Vol 21 (6) ◽  
pp. 684-691 ◽  
Author(s):  
Jo Bønding Andreasen ◽  
Anne-Mette Hvas ◽  
Kirsten Christiansen ◽  
Hanne Berg Ravn
Keyword(s):  
Cardiac Surgery ◽  
Platelet Count ◽  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Activated Partial Thromboplastin Time ◽  
Clotting Time ◽  
Coagulation Tests

AbstractBackgroundSuccessful management of bleeding disorders after congenital heart surgery requires detection of specific coagulation disturbances. Whole-blood rotation thromboelastometry (RoTEM®) provides continuous qualitative haemostatic profiles, and the technique has shown promising results in adult cardiac surgery.SettingTo compare the performance of RoTEM®with that of conventional coagulation tests in children, we conducted a descriptive study in children undergoing congenital cardiac surgery. For that purpose, 60 children were enrolled and had blood samples taken before, immediately after, and 1 day after surgery. Conventional coagulation tests included: activated partial thromboplastin time, prothrombin time, fibrinogen, fibrin D-dimer, thrombin clotting time, factor XIII, and platelet count.ResultsPost-surgical haemostatic impairment was present to some degree in all children, as seen by pronounced changes in activated partial thromboplastin time, prothrombin time, thrombin clotting time, and platelet count, as well as RoTEM®analysis. RoTEM®showed marked changes in clotting time – prolonged by 7–18% – clot formation time – prolonged by 46–71% – maximum clot firmness – reduced by 10–19%, and maximum velocity – reduced by 29–39%. Comparison of the two techniques showed that conventional coagulation tests and RoTEM®performed equally well with regard to negative predictive values for excessive post-operative drain production – more than 20 millilitres per kilogram per 24 hours after surgery – with an area under the curve of approximately 0.65.ConclusionRoTEM®can detect haemostatic impairments in children undergoing cardiac surgery and the method should be considered as a supplement in the perioperative care of the children where targeted transfusion therapy is necessary to avoid volume overload.

scholarly journals Management of Major Obstetric Haemorrhage using ROTEM Point-of-Care Haemostasis Analysers Can Reduce Blood Product usage Without Increasing Fibrinogen Replacement Therapy

2018 ◽  
Vol 11 (3) ◽  
pp. 1167-1176
Author(s):  
Beatrice O. Ondondo
Keyword(s):  
Blood Loss ◽  
Replacement Therapy ◽  
Blood Product ◽  
Point Of Care ◽  
Blood Products ◽  
Transfusion Therapy ◽  
Product Usage ◽  
Obstetric Haemorrhage ◽  
Coagulation Tests ◽  
Fibrinogen Replacement Therapy

Major obstetric haemorrhage (MOH) is a leading cause of maternal death and morbidity, with the majority of deaths occurring within four hours of delivery. Therefore, prompt identification of women at risk of MOH is crucial for the rapid assessment and management of blood loss to urgently restore haemodynamic stability. Furthermore, as the rate of blood loss during MOH can increase rapidly in the time when laboratory results are awaited, the management of MOH could benefit from point-of-care coagulation testing by the ROTEM analyser which has a quicker turnaround time compared to standard laboratory coagulation tests. A number of studies indicate that ROTEM-based management of MOH has resulted in a significant reduction in massive transfusions and decreased transfusion of concentrated red cells (CRC) and fresh frozen plasma (FFP) due to a reduction in total blood loss. Several reports which have linked MOH to the depletion of fibrinogen reserves indicate that the reduction in CRC and FFP transfusions is largely due to an increase in early fibrinogen replacement therapy which corrects hypofibrinogenemia. This short report discusses preliminary findings on the impact of ROTEM point-of-care haemostasis analyser on the transfusion of various blood products to obstetric women experiencing MOH at the Royal Gwent Hospital in South wales. The number of blood products transfused following decisions based on the ROTEM analyser measurements (ROTEM group) was compared to historical transfusion data before the ROTEM analyser became available (Pre-ROTEM group). Blood product transfusion in the Pre-ROTEM group was guided by measurements of standard laboratory coagulation tests in conjunction with the established major haemorrhage protocols at the time. The findings indicate that the ROTEM analyser was effective in managing MOH at point-of-care and led to a reduction in the transfusion of CRC, FFP and platelets. However, contrary to published studies, the reduction in blood product usage was not accompanied by an increase in fibrinogen replacement transfusion therapy, suggesting that the ROTEM’s FIBTEM assay accurately quantified fibrinogen levels based on fibrin-clot firmness to enable an early diagnosis of hypofibrinogenemia. Early establishment of the absence of hypofibrinogenemia helped to prevent unnecessary transfusion of fibrinogen concentrate in this study. These findings support the adoption of routine use of ROTEM analysers at point-of-care on labour wards to manage MOH and reduce fibrinogen replacement therapy. The ease of use and rapidity of ROTEM tests could enable departure from globally directed correction of coagulopathy during MOH to a more focussed and precise target transfusion therapy, which will ultimately reduce blood product wastage (including fibrinogen concentrate) whilst minimising transfusion-associated side effects such as alloimmunisation, circulatory overload and dilutional coagulopathy.

scholarly journals Effect of storage time on prothrombin time and activated partial thromboplastin time: study at a tertiary care center in Kashmir valley

2018 ◽  
Vol 4 (7) ◽  
pp. 182
Author(s):  
Sajad Geelani ◽  
Gul Sajad Wani ◽  
Subuh Parvez Khan ◽  
Syed Mudasir Qadri ◽  
Javid Rasool ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Storage Temperature ◽  
Care Center ◽  
Tertiary Care ◽  
Activated Partial Thromboplastin Time ◽  
Time Interval ◽  
Tertiary Care Center ◽  
Kashmir Valley ◽  
Coagulation Tests

<p class="abstract"><strong>Background:</strong> Prothrombin time (PT) and activated partial thromboplastin time (APTT) are tests of haemostasis commonly employed in the evaluation of coagulopathies. Storage temperature and time interval between sample collection and testing can have a significant effect on results of coagulation tests. The aims of the study were investigate whether storage temperature and time influence the results of routine coagulation tests and whether any changes caused by delayed analysis results in a clinically relevant difference, as well as to establish our own acceptable storage temperature and time guidelines.</p><p class="abstract"><strong>Methods:</strong> This study was conducted at Department of Clinical Haematology, in a tertiary care center in Kashmir valley. This study included 50 cases. Individuals with chronic liver diseases or cardiovascular disorders, subjects on anticoagulant therapy were excluded. 25 samples were observed at room temperature (RT) and 25 samples at 2-8°C. PT and APTT was measured at 0, 2, 4, 8, 16 and 24 hours both at RT and 2-8°C. Findings at 0 hr were compared to findings at 2,4, 8,16 and 24 hours in both the groups.  </p><p class="abstract"><strong>Results:</strong> In case of PT, reliable results were obtained up to 24 hrs either kept at RT or at 2 to 8°C and for APTT reliable results were obtained up to 4 hours kept at RT or at 2 to 8°C as there was no significant change during this period.</p><p class="abstract"><strong>Conclusions:</strong> Coagulation test should be performed as soon as possible with PT being performed before 24 hours and APTT before 4 hours of collection of sample irrespective of whether the sample has been preserved at RT or in refrigerator.</p>

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