The role of rotational thromboelastometry in real time assessment of haemostasis in surgical settings

Abstract

In the settings of trauma, liver transplantation and major surgery multifactorial coagulopathies are frequently encountered. The treatment of acutely bleeding patients is critically compromised by monitoring with standard available routine coagulation tests. In contrast to conventional tests, rotational thromboelastometry (ROTEM) provides an automated measurement of interactive dynamic haemostatic processes in whole blood starting with initial haemostasis up to and including fibrinolysis at a given time point. Especially fibrinogen, platelet dysfunction and hyperfibrinolysis pose diagnostic gaps. The aim of this report was to highlight the usefulness of ROTEM in making the correct diagnosis and adoption of therapeutic approaches in a timely manner in liver transplantation and trauma. We describe the value of ROTEM in two haemostatically compromised patients. In the first case, we present the ROTEM-based dynamic assessment and goal-directed treatment of acute haemorrhage in a liver transplant recipient. In the second case, after operation a multitraumatised patient developed uncontrolled massive bleeding unresponsive to conventional treatment and recombinant activated factor VII (rFVIIa) administration. The cessation of bleeding was achieved after guided therapy according to ROTEM results. In orthotopic liver transplantation and severely injured trauma patients ROTEM enables rapid and accurate detection and the differential diagnosis of multifactorial coagulopathies. Also, it provides the basis of rational approach to the use of blood component therapy and pharmacological interventions.