Rotational thrombelastometry: a step forward to safer patient care?

Fuat H Saner

doi:10.1186/s13054-014-0706-7

Abstract

The study by Hincker and colleagues indicated that the perioperative use of rotational thrombelastometry (ROTEM™) could predict thromboembolic events in 90% of the cases in non-cardiac surgery. Viscoelastic tests (VETs) - ROTEM™ and thrombelastography (TEG™) - are used mainly to predict bleeding complications. Most conventional coagulation tests, like prothrombin time and activated partial thromboplastin time, can identify a disturbance in plasmatic hemostasis. However, the relevance of these assays is limited to the initiation phase of coagulation, whereas VETs are designed to assess the whole clotting kinetics and strength of the whole blood clot and reflect more the interaction between procoagulants, anticoagulants, and platelets. The first reports about VET and hypercoagulable state were published more than 25 years ago. Since then, several studies with different quality and sample size have been published, sometimes with conflicting results. A systematic review about hypercoagulable state and TEG™ indicated that further studies are needed to recommend VETs as a screening tool to predict postoperative thrombosis.

Highlights

The study by Hincker and colleagues indicated that the perioperative use of rotational thrombelastometry (ROTEMTM) could predict thromboembolic events in 90% of the cases in non-cardiac surgery
In a previous issue of Critical Care, Hincker and colleagues [1] identified with preoperative rotational thrombelastometry (ROTEMTM, TEM International, München, Germany) analysis patients at high risk for postoperative thromboembolic events
The authors indicated that in all four tests - extrinsic thrombelastometry, intrinsic thrombelastometry, fibrinogen thrombelastometry, and aprotinin thrombelastometry - the clot formation time was significantly shorter and maximum clot formation was significant higher compared with healthy controls, indicating a risk for thrombosis

Summary

Introduction

The study by Hincker and colleagues indicated that the perioperative use of rotational thrombelastometry (ROTEMTM) could predict thromboembolic events in 90% of the cases in non-cardiac surgery. In a previous issue of Critical Care, Hincker and colleagues [1] identified with preoperative rotational thrombelastometry (ROTEMTM, TEM International, München, Germany) analysis patients at high risk for postoperative thromboembolic events. TEGTM has had different periods of popularity but has never been routinely used for perioperative coagulation

Results

Conclusion