thromboelastogram

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FYI

 J Thromb Haemost. 2007 Feb;5(2):289-95. Epub 2006 Nov 16. 

Diagnosis of early coagulation abnormalities in trauma patients by rotation
thrombelastography.

Rugeri L, Levrat A, David JS, Delecroix E, Floccard B, Gros A, Allaouchiche B,
Negrier C.

Laboratory of Haemostasis, Edouard Herriot Hospital, Hospices Civils de Lyon and
Claude Bernard University, Lyon, France.

Background: Reagent-supported thromboelastometry with the rotation thrombelastography (e.g. ROTEM((R))) 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 = 0.66, P < 0.0001), between activated partial thromboplastin time and CFT-INTEM (r = 0.91, P < 0.0001), between fibrinogen level and CA(10)-FIBTEM (r = 0.85, P < 0.0001), and between platelet count and CA(15)-INTEM (r = 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-of-care device that rapidly detects systemic changes of in vivo coagulation in trauma patients, and it might be a helpful device in guiding transfusion. 
PMID: 17109736 [PubMed - in process]


Stephen S. Luk, MD, FACS, FCCP
Assistant Professor of Surgery
Medical Director, ATOM Course
Hartford Hospital
EMS/Trauma Program
80 Seymour Street
Hartford, CT 06102-5037
(860) 545-3766
sluk at harthosp.org 


>>> "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za> 2/8/2007 5:25 AM >>>
Yoram

yes - it works. Just need the rapid-type machine and you can get a result in 10 mins - much faster that INR / FBC

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za 
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302



-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]On Behalf Of YoramKl at clalit.org.il 
Sent: Thursday, February 08, 2007 11:17 AM
To: trauma-list at trauma.org 
Subject: thromboelastogram



Dear list members
Does anybody have any experience with the TEG (thromboelastogram) during trauma related massive transfusion?
Thanks  
Yoram Klein
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of trauma-list-request at trauma.org 
Sent: Tuesday, February 06, 2007 2:01 PM
To: trauma-list at trauma.org 
Subject: trauma-list Digest, Vol 44, Issue 7

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