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Uses of thromboelastometry

Created: 30/8/2005
 

Cardiac surgery

Cardiac surgery has become an area, in which application of thrombelastometry has contributed significantly to an optimisation of therapy.

Except for surgical bleeding, the most often observed problems arise from:

 the management of heparin dosage and of protamine chloride
 hyperfibrinolysis
 dilution
 haemostasis disorders by plasma expanders and hypothermia
 consumption of coagulation factors and platelets
 activation of coagulation and hyperfibrinolysis
 other drug effects

A differentiation of surgical bleeding from a true haemostasis disorder is important and influences therapeutic strategies. Thromboelastometry analysis is able to characterise the majority of relevant haemostasis disorders within a few minutes. This is not only a benefit for the outcome of the patient but also an economical advantage. Interventions can be made faster, and often with fewer blood products or other expensive therapies.

Bleeding disorders

Coagulation assays may sometimes generate results which do not reflect the clinical situation. Pathological prothrombin time or activated partial thromboplastin time results initiate additional tests which can often not be performed in the same location. This delays therapeutic decisions, may postpone surgery and increases costs. Thromboelastometry is sensitive for factor XIII and reflects any disturbances in fibrinogen polymerisation or the interaction between fibrinogen and platelets much better than clotting assays, and should be used in those cases.

In some cases of haemophilia, especially with inhibitors, ROTEM® has been successfully used in order to manage substitution therapy with factor VIIa, which is difficult to manage with clotting assays. Also, for other cases of haemophilia, thromboelastometry may give a better picture on the clot stability than clotting tests, which are sometimes subject to interference by lupus anticoagulants.

ArticleDate:20050830
SiteSection: Article
 
   
    
                                            
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