Trombelastometria rotaţională (ROTEM) – o nouă metodă de diagnostic al tulburărilor complexe de hemostază la pacientul politraumatizat

Abstract

The coagulopathy is one of the most frequent causes of early posttraumatic mortality. The changes induced by multiple trauma in the coagulation cascade lead to different shapes: from massive bleeding to thrombosis, with different time evolution. Acute intrinsic coagulopathy arising in severely injured trauma patients is now termed trauma-induced coagulopathy (TIC) and is an emergent property of tissue injury combined with hypoperfusion. Mechanisms contributing to TIC include: coagulation factor and platelet consumption, platelet dysfunction, hyperfibrinolysis. But it also could be induced by iatrogenic factors such as: massive transfusion, hypothermia, quantity and type of replacement solutions. Rotational thrombelastometry (ROTEM) is a rapid method to diagnose the type of coagulopathy, showing graphical and numerical data and provides information on the rapidity of coagulation initiation, kinetics of clot growth, clot strength and breakdown by measuring the viscoelastic changes of clot formation in whole blood under low shear conditions. This method can give a „big picture“ of the coagulation cascade, and it can represent a start for the coagulopathy treatment guideline in multiple trauma.