scholarly journals The Utilization of Viscoelastic Testing to Guide Blood Component Therapy and Adjunctive Hemostatic Therapy for Postpartum Hemorrhage: A Narrative Review

2019 ◽  
pp. 272-286
Author(s):  
Baumgartner S ◽  
Shariff F ◽  
Vande Lune SA ◽  
Zackariya N ◽  
Grisoli A ◽  
...  
Keyword(s):  
Postpartum Hemorrhage ◽  
Point Of Care ◽  
Narrative Review ◽  
Blood Component ◽  
Clinical Parameters ◽  
Rotational Thromboelastometry ◽  
Coagulation Tests ◽  
Blood Component Therapy ◽  
History Of ◽  
Hemostatic Therapy

This narrative review discusses the history of the pathophysiologic principles and utilization of point-of-care (POC) viscoelastic tests (VETs) in the definition and treatment of postpartum hemorrhage (PPH). This paper addresses the epidemiology of PPH, describes the hemostatic changes that occur in pregnancy and in PPH, and demonstrates the utilization of viscoelastic testing in the identification and treatment of patients with PPH. Additionally, a description of rotational thromboelastometry (ROTEM) and thromboelastography (TEG), the two most commonly used VETs, is detailed in this paper. VETs have only recently been used to guide blood component therapy (BCT) in trauma in the last decade. The recent increased utilization of VETs to guide BCT in PPH is following a similar trend with a delay of ten years. In a similar fashion to the trauma literature, which expanded greatly within this last decade, the literature concerning the use of VETs in PPH has also increased in the last few years. However, because of differing pathophysiologies associated with the coagulopathy of PPH verses traumatic-induced coagulopathy (TIC), utilization of VETs has been more refined and focused on the VETs’ capacity to determine low fibrinogen and to guide the utilization of blood components and prohemostatic agents. The identification and treatment of PPH depends on clinical parameters, conventional coagulation tests (CCTs) including Clauss fibrinogen, and VETs. Successful treatment of PPH will no doubt include utilization of all three strategies with an increasing utilization of VETs in the future.

scholarly journals Viscoelastic Hemostatic Assays for Postpartum Hemorrhage

2021 ◽  
Vol 10 (17) ◽  
pp. 3946
Author(s):  
Alyson E. Liew-Spilger ◽  
Nikki R. Sorg ◽  
Toby J. Brenner ◽  
Jack H. Langford ◽  
Margaret Berquist ◽  
...  
Keyword(s):  
Postpartum Hemorrhage ◽  
Point Of Care ◽  
Blood Component ◽  
Surgical Trauma ◽  
Point Of Care Test ◽  
Coagulation Tests ◽  
Blood Component Therapy ◽  
Acute Fatty Liver ◽  
Correct Technique ◽  
Point Of Care Tests

This article discusses the importance and effectiveness of viscoelastic hemostatic assays (VHAs) in assessing hemostatic competence and guiding blood component therapy (BCT) in patients with postpartum hemorrhage (PPH). In recent years, VHAs such as thromboelastography and rotational thromboelastometry have increasingly been used to guide BCT, hemostatic adjunctive therapy and prohemostatic agents in PPH. The three pillars of identifying hemostatic competence include clinical observation, common coagulation tests, and VHAs. VHAs are advantageous because they assess the cumulative contribution of all components of the blood throughout the entire formation of a clot, have fast turnaround times, and are point-of-care tests that can be followed serially. Despite these advantages, VHAs are underused due to poor understanding of correct technique and result interpretation, a paucity of widespread standardization, and a lack of large clinical trials. These VHAs can also be used in cases of uterine atony, preeclampsia, acute fatty liver of pregnancy, amniotic fluid embolism, placental abruption, genital tract trauma, surgical trauma, and inherited and prepartum acquired coagulopathies. There exists an immediate need for a point-of-care test that can equip obstetricians with rapid results on developing coagulopathic states. The use of VHAs in predicting and treating PPH, although in an incipient state, can fulfill this need.

scholarly journals A Prospective Randomized Clinical Trial of Efficacy of Algorithm-Based Point of Care Guided Hemostatic Therapy in Cyanotic Congenital Heart Disease Surgical Patients

2019 ◽  
Vol 03 (01) ◽  
pp. 08-16
Author(s):  
Ameya Karanjkar ◽  
Poonam Malhotra Kapoor ◽  
Sandeep Sharan ◽  
Vandana Bhardwaj ◽  
Vishwas Malik ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Point Of Care ◽  
Fresh Frozen Plasma ◽  
Surgical Patients ◽  
Blood Component ◽  
Chest Drain ◽  
Packed Red Blood Cells ◽  
Mechanical Ventilation Duration ◽  
Blood Component Therapy ◽  
Hemostatic Therapy

Abstract Objective Point of care (POC) testing-based algorithm-guided hemostatic therapy has been used in adult as well as pediatric cardiac surgical patients to administer blood components. The authors hypothesized that implementation of POC-based algorithm in pediatric cyanotic congenital surgical patients would reduce the exposure to blood component therapy and improve the clinical outcome. Design Prospective randomized control trial. Setting Single-center academic institute. Participants One hundred seventy pediatric congenital cyanotic surgical patients. Intervention Implementation of POC and conventional tests-based algorithms. Measurements and Main Results Algorithm-based blood component therapy was administered in each group. There were no group differences regarding the demographic, clinical, and laboratory characteristics. Amount of packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, and cryoprecipitate (primary outcomes) administered was significantly lower in POC group than that in the conventional group (p < 0.001). Among the secondary outcomes, the chest drain output at 6, 12, and 24 hours and number of re-explorations was comparable among both the groups. The duration of mechanical ventilation, duration of intensive care unit (ICU) stay, and hospital stay was significantly short in POC group (p = 0.008, <0.001 and 0.019, respectively). Conclusion Implementation of POC-based algorithm-guided hemostatic therapy reduced the exposure to blood and blood component therapy and was associated with reduced ICU and hospital stay in pediatric congenital cyanotic surgical patients.

Diagnosis and Treatment of Trauma-Induced Coagulopathy by Viscoelastography

2020 ◽  
Vol 46 (02) ◽  
pp. 134-146 ◽  
Author(s):  
Jan Hartmann ◽  
Mark Walsh ◽  
Anne Grisoli ◽  
Anthony V. Thomas ◽  
Faisal Shariff ◽  
...  
Keyword(s):  
Trauma Patient ◽  
Clinical Outcomes ◽  
Blood Product ◽  
Blood Component ◽  
Trauma Resuscitation ◽  
Rotational Thromboelastometry ◽  
Trauma Induced Coagulopathy ◽  
Coagulation Tests ◽  
Blood Component Therapy ◽  
Compare And Contrast

AbstractThis article explores the application of viscoelastic tests (VETs) in trauma-induced coagulopathy and trauma resuscitation. We describe the advantages of VETs over conventional coagulation tests in the trauma setting and refer to previous disciplines in which VET use has reduced blood product utilization, guided prohemostatic agents, and improved clinical outcomes such as the mortality of critically bleeding patients. We describe different VETs and provide guidance for blood component therapy and prohemostatic therapy based on specific VET parameters. Because the two most commonly used VET systems, rotational thromboelastometry and thromboelastography, use different activators and have different terminologies, this practical narrative review will directly compare and contrast these two VETs to help the clinician easily interpret either and use the interpretation to determine hemostatic integrity in the bleeding trauma patient. Finally, we anticipate the future of new viscoelastic technologies that can be used in this setting.

Blood component therapy in postpartum hemorrhage

Transfusion ◽  
2009 ◽  
Vol 49 (11) ◽  
pp. 2430-2433 ◽  
Author(s):  
Andra H. James ◽  
Michael J. Paglia ◽  
Terry Gernsheimer ◽  
Chad Grotegut ◽  
Betty Thames
Keyword(s):  
Postpartum Hemorrhage ◽  
Blood Component ◽  
Blood Component Therapy

Is thromboelastography reliable in postpartum coagulopathies? Two case reports and a literature review

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Elif E. Gultekin-Elbir ◽  
J. Peter R. Pelletier ◽  
Kendra R. Sylvester-Armstrong ◽  
Mehmet R. Genc
Keyword(s):  
Case Reports ◽  
Damage Control ◽  
International Normalized Ratio ◽  
Blood Component ◽  
Reference Ranges ◽  
Coagulation Tests ◽  
Maternal Morbidity And Mortality ◽  
Blood Component Therapy ◽  
Intervention Goal

AbstractPostpartum hemorrhage (PPH) is an underestimated problem in labor and delivery units and remains a leading cause of maternal morbidity and mortality worldwide. Managing PPH starts with immediate recognition and intervention. Goal-directed massive transfusion protocol can be achieved by properly monitoring the maternal coagulation profile during severe obstetric hemorrhage. Conventional coagulation tests (prothrombin time, activated partial thromboplastin time, international normalized ratio, fibrinogen analysis, platelet count) have long turnaround times (occasionally >60 min and provide little information about the in vivo condition of hemostasis) compared to viscoelastic tests (VETs) (available results within 10–30 min). The outcome in actively hemorrhaging patients can be optimized by VETs, including thromboelastography (TEG), rotational thromboelastometry and Sonoclot, providing more individualized blood component therapy compared to traditional 1:1:1 ‘damage control resuscitation’ ratios of blood transfusion strategy. The main limitations of the efficacy of VETs include, but are not limited to, the lack of validation, not having well-established reference ranges for each patient group, results affected by fluid resuscitation regimes and consistent operator proficiency. Although there is limited data with the use of VETs in obstetric patients, the value of VETs is supported by guidelines with increasing evidence. This article will demonstrate two obstetric cases to evaluate the reliability of the TEG in the management of postpartum coagulopathies. The lesson we took from our two cases is presented.

scholarly journals Viscoelastic coagulation test for liver transplantation

2020 ◽  
Vol 15 (2) ◽  
pp. 143-151
Author(s):  
Sun Young Park
Keyword(s):  
Liver Transplantation ◽  
Management Strategy ◽  
Point Of Care ◽  
Turnaround Time ◽  
Coagulation Test ◽  
Blood Management ◽  
Coagulation Tests ◽  
Perioperative Monitoring ◽  
Plasmatic Coagulation ◽  
Hemostatic Therapy

Coagulation and transfusion management in patients undergoing liver transplantation is challenging. Proper perioperative monitoring of hemostasis is essential to predict the risk of bleeding during surgery, to detect potential causes of hemorrhage in time, and to guide hemostatic therapy. The value of conventional coagulation test is questionable in the acute perioperative setting due to their long turnaround time and the inability to adequately reflect the complex changes in hemostasis in patients with liver disease. Viscoelastic coagulation tests provide simultaneous measurement of multiple aspects of whole-blood coagulation including plasmatic coagulation and fibrinolytic factors and inhibitors that reflect most aspects of hemostasis. Coagulation initiation, mechanical clot stability, and fibrinolysis can be estimated immediately using point-of-care techniques. Therefore, viscoelastic coagulation tests including ROTEM & TEG would be useful to guide patient blood management strategy during liver transplantation.

scholarly journals Whole Blood, Fixed Ratio, or Goal-Directed Blood Component Therapy for the Initial Resuscitation of Severely Hemorrhaging Trauma Patients: A Narrative Review

2021 ◽  
Vol 10 (2) ◽  
pp. 320
Author(s):  
Mark Walsh ◽  
Ernest E. Moore ◽  
Hunter B. Moore ◽  
Scott Thomas ◽  
Hau C. Kwaan ◽  
...  
Keyword(s):  
Whole Blood ◽  
Fixed Ratio ◽  
Narrative Review ◽  
Blood Component ◽  
Trauma Patients ◽  
Initial Resuscitation ◽  
Blood Component Therapy ◽  
Historical Developments ◽  
Comparative Trials ◽  
Selection Of

This narrative review explores the pathophysiology, geographic variation, and historical developments underlying the selection of fixed ratio versus whole blood resuscitation for hemorrhaging trauma patients. We also detail a physiologically driven and goal-directed alternative to fixed ratio and whole blood, whereby viscoelastic testing guides the administration of blood components and factor concentrates to the severely bleeding trauma patient. The major studies of each resuscitation method are highlighted, and upcoming comparative trials are detailed.

scholarly journals Hemorrhagic Resuscitation Guided by Viscoelastography in Far-Forward Combat and Austere Civilian Environments: Goal-Directed Whole-Blood and Blood-Component Therapy Far from the Trauma Center

2022 ◽  
Vol 11 (2) ◽  
pp. 356
Author(s):  
James H. Lantry ◽  
Phillip Mason ◽  
Matthew G. Logsdon ◽  
Connor M. Bunch ◽  
Ethan E. Peck ◽  
...  
Keyword(s):  
Whole Blood ◽  
Blood Component ◽  
Trauma Centers ◽  
Blood Products ◽  
Massive Blood Loss ◽  
Initial Resuscitation ◽  
Blood Component Therapy ◽  
Resuscitation Strategy ◽  
History Of ◽  
Current Guidelines

Modern approaches to resuscitation seek to bring patient interventions as close as possible to the initial trauma. In recent decades, fresh or cold-stored whole blood has gained widespread support in multiple settings as the best first agent in resuscitation after massive blood loss. However, whole blood is not a panacea, and while current guidelines promote continued resuscitation with fixed ratios of blood products, the debate about the optimal resuscitation strategy—especially in austere or challenging environments—is by no means settled. In this narrative review, we give a brief history of military resuscitation and how whole blood became the mainstay of initial resuscitation. We then outline the principles of viscoelastic hemostatic assays as well as their adoption for providing goal-directed blood-component therapy in trauma centers. After summarizing the nascent research on the strengths and limitations of viscoelastic platforms in challenging environmental conditions, we conclude with our vision of how these platforms can be deployed in far-forward combat and austere civilian environments to maximize survival.

scholarly journals Thrombelastometry guided blood-component therapy after cardiac surgery: a randomized study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Martin Haensig ◽  
Joerg Kempfert ◽  
Pia-Maria Kempfert ◽  
Evaldas Girdauskas ◽  
Michael Andrew Borger ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Point Of Care ◽  
Postoperative Bleeding ◽  
Treatment Algorithm ◽  
Cardiac Surgical Procedures ◽  
Blood Component ◽  
Transfusion Requirements ◽  
Increased Risk ◽  
Significant Difference ◽  
Blood Component Therapy

Abstract Background Significant bleeding is a well known complication after cardiac surgical procedures and is associated with worse outcome. Thrombelastometry (ROTEM®) allows point-of-care testing of the coagulation status but only limited data is available yet. The aim was to evaluate the ROTEM®-guided blood component therapy in a randomized trial. Methods In case of significant postoperative bleeding (> 200 ml/h) following elective isolated or combined cardiac surgical procedures (including 14% re-do procedures and 4% requiring circulatory arrest) patients were randomized to either a 4-chamber ROTEM®-guided blood-component transfusion protocol or received treatment guided by an algorithm based on standard coagulation testing (control). One hundred four patients (mean age: 67.2 ± 10.4 years, mean log. EuroSCORE 7.0 ± 8.8%) met the inclusion criteria. Mean CPB-time was 112.1 ± 55.1 min., mean cross-clamp time 72.5 ± 39.9 min. Results Baseline demographics were comparable in both groups. Overall there was no significant difference in transfusion requirements regarding red blood cells, platelets, plasma, fibrinogen or pooled factors and the re-thoracotomy rate was comparable (ROTEM®: 29% vs. control: 25%). However, there was a trend towards less 24-h drainage loss visible in the ROTEM®-group (ROTEM®: 1599.1 ± 834.3 ml vs. control: 1867.4 ± 827.4 ml; p = 0.066). In the subgroup of patients with long CPB-times (> 115 min.; n = 55) known to exhibit an increased risk for diffuse coagulopathy ROTEM®-guided treatment resulted in a significantly lower 24-h drainage loss (ROTEM®: 1538.2 ± 806.4 ml vs. control: 2056.8 ± 974.5 ml; p = 0.032) and reduced 5-year mortality (ROTEM®: 0% vs. control: 15%; p = 0.03). Conclusion In case of postoperative bleeding following cardiac surgical procedures a treatment algorithm based on “point-of-care” 4-chamber ROTEM® seems to be at least as effective as standard therapy. In patients with long CPB-times ROTEM®-guided treatment may result in less bleeding, a marked reduction in costs and long-term mortality. Trial registration German Clinical Trials Register, TRN: DRKS00017367, date of registration: 05.06.2019, ‘retrospectively registered’.

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