A comparison of two viscoelastic testing systems for goal-guided administration of fibrinogen concentrate in severe trauma – TEG® and ROTEM®

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Authors
  1. Nascimento, B.
Corporate Authors
Defence Research and Development Canada, Toronto Research Centre , Toronto ON (CAN)
Abstract
Given the increased use of both thrombelastography (TEG®) and rotational thromboelastometry (ROTEM®) for hemorrhage control in trauma and surgery and similarities among various tests between the two, it is important to determine whether the two are interchangeable or one is superior to the other. We thus conducted a comparative study of functional fibrinogen assays using TEG® and ROTEM® in trauma to determine 1) their interchangeability for measuring coagulation profiles in all trauma patients screened at admission and randomized to receive fibrinogen concentrate and placebo, 2) capability to predict blood transfusion requirements, diagnose coagulopathy and detect coagulation effects of fibrinogen concentrate in the randomized controlled trial. Overall, TEG and ROTEM parameter values were correlated, but were significantly different, and their agreement fell outside acceptable limits and thus were not interchangeable, arguably due to differences in both devices and assay reagents used. Clinically, TEG Maximum Amplitude and ROTEM® Maximum Clot Firmness showed reasonable predictive accuracy for plasma transfusion and strong predictive accuracy for coagulopathy, but poor accuracy for any red blood cells and cryoprecipitate transfusion. Both TEG and ROTEM detected significant changes in maximum clot strength/firmness by fibrinogen treatment and over hospitalization time. In addition, ROTEM detected changes in coagulation time. Different algorithms for TEG and ROTEM need to b
Keywords
TEG;ROTEM;fibrinogen concentrate;hemorrhage;coagulopathy;trauma
Report Number
DRDC-RDDC-2016-C104 — Contract Report
Date of publication
18 Apr 2016
Number of Pages
20
DSTKIM No
CA042421
CANDIS No
803567
Format(s):
Electronic Document(PDF)

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