FIBTEM A10 Research Articles

Use of fibrin-based thromboelastometry for cryoprecipitate transfusion in cardiac surgery involving deep hypothermic circulatory arrest during cardiopulmonary bypass

We aimed to assess the predictive value of fibrin-based thromboelastometry performed before weaning from cardiopulmonary bypass (CPB) for cryoprecipitate administered to correct the bleeding diathesis after CPB involving deep hypothermic circulatory arrest. Eleven patients undergoing aortic surgery were enrolled. The arterial blood was withdrawn before skin incision, 30 min before CPB weaning (Cweaning), 5 min after protamine reversal (Preversal) and at closure of the sternum to run intrinsically activated INTEM, heparinase-treated HEPTEM, extrinsically activated EXTEM and platelet-inhibited FIBTEM analysis, platelet count, fibrinogen, prothrombin time (international normalized ratio) and activated partial thromboplastin time. The predicted value of FIBTEM A10 obtained during CPB for cryoprecipitate transfusion at Preversal was calculated. The cut-off points for FIBTEM A10 to reflect fibrinogen of 200 mg/dl at Preversal were 5 mm (P = 0.15). FIBTEM A10 at Preversal and Cweaning showed correlations as follows: FIBTEM A10 at Preversal = 0.02 + 1.42 × FIBTEM A10 at Cweaning (r² = 0.80). The cut-off value for FIBTEM A10 at Cweaning to determine whether to prepare cryoprecipitate in advance during CPB was calculated to be 3 mm, and the positive and negative predictability for FIBTEM A10 of 3 or less versus more than 3 at Cweaning for the necessity of cryoprecipitate transfusion at Preversal (A10 ≤ 5 versus > 5) were 100 and 80%, respectively. This study showed that fibrinogen reflected in FIBTEM during pump can be used to estimate FIBTEM after Preversal and the amount of cryoprecipitate needed for replacing mainly the fibrinogen could be predicted with high sensitivity and specificity.

Rotation thromboelastometry detects thrombocytopenia and hypofibrinogenaemia during orthotopic liver transplantation

Orthotopic liver transplantation can be associated with haemorrhage, particularly in patients with severe liver dysfunction. We assessed the value of rotation thromboelastometry (ROTEM) to monitor coagulation in the operating theatre, its correlation with routine laboratory findings, and its ability to guide platelet (Plt) and fibrinogen (Fg) transfusion. Twenty-three patients were included in this prospective observational study. Laboratory tests and ROTEM tests (EXTEM, INTEM, FIBTEM, and APTEM) were performed six times during the procedure. Correlations between laboratory findings and ROTEM parameters were sought. Thresholds for ROTEM parameters were determined with receiver-operating characteristic (ROC) curve analysis according to Plt count and Fg levels. Clot amplitude at 10 min (A10) of EXTEM was well correlated with Plt count and Fg levels (R(2)=0.46 and 0.52, respectively, P<0.0001). FIBTEM A10 was correlated with Fg (R(2)=0.55, P<0.0001). ROC analysis showed that EXTEM A10 with a threshold of 29 mm predicted thrombocytopenia with a sensitivity of 79% and a specificity of 60%, and a threshold of 26 mm predicted hypofibrinogenaemia with a sensitivity of 83% and a specificity of 75%. ROTEM is useful for the global assessment of coagulation in the operating theatre. EXTEM was the most informative for assessing the whole coagulation process and A10 showed value in guiding Plt and Fg transfusion.

Aspects génétiques de la maladie de Creutzfeldt-Jakob : intérêt de l'étude moléculaire du gène PrP

Postpartum haemorrhage (PPH) is caused by obstetric complications but may be exacerbated by haemostatic impairment. In a 10-year programme of research we have established that haemostatic impairment is uncommon in moderate PPH and that fibrinogen falls earlier than other coagulation factors. Laboratory Clauss fibrinogen and the point-of-care surrogate measure of fibrinogen (FIBTEM A5 measured on the ROTEM® machine) are predictive biomarkers for progression from early to severe PPH, the need for blood transfusion and invasive procedures to control haemorrhage. Fibrinogen replacement is not required in PPH unless the plasma level falls below 2 g/L or the FIBTEM A5 is below 12 mm. Deficiencies of coagulation factors other than fibrinogen are uncommon even during severe PPH, and ROTEM® monitoring can inform withholding FFP safely in most women. In the absence of placental abruption, clinically significant thrombocytopenia is uncommon unless the platelet count is low before the bleed started, or very large bleeds (>5000 mL) occur. Measuring blood loss is feasible in routine practice during PPH and is more accurate than estimation. These research findings have been collated to design an ongoing quality improvement programme for all maternity units in Wales called OBS Cymru (Wales) (The Obstetric Bleeding Strategy for Wales).

Les thérapeutiques pharmacologiques dans la maladie d'Alzheimer : situation en 1994 et perspectives

Postpartum haemorrhage (PPH) is caused by obstetric complications but may be exacerbated by haemostatic impairment. In a 10-year programme of research we have established that haemostatic impairment is uncommon in moderate PPH and that fibrinogen falls earlier than other coagulation factors. Laboratory Clauss fibrinogen and the point-of-care surrogate measure of fibrinogen (FIBTEM A5 measured on the ROTEM® machine) are predictive biomarkers for progression from early to severe PPH, the need for blood transfusion and invasive procedures to control haemorrhage. Fibrinogen replacement is not required in PPH unless the plasma level falls below 2 g/L or the FIBTEM A5 is below 12 mm. Deficiencies of coagulation factors other than fibrinogen are uncommon even during severe PPH, and ROTEM® monitoring can inform withholding FFP safely in most women. In the absence of placental abruption, clinically significant thrombocytopenia is uncommon unless the platelet count is low before the bleed started, or very large bleeds (>5000 mL) occur. Measuring blood loss is feasible in routine practice during PPH and is more accurate than estimation. These research findings have been collated to design an ongoing quality improvement programme for all maternity units in Wales called OBS Cymru (Wales) (The Obstetric Bleeding Strategy for Wales).