CLINICAL UTILITY OF ROTATIONAL THROMBOELASTOMETRY IN DETECTING HEMOSTATIC DISORDERS
Keywords:
coagulopathy, rotational thromboelastometry, sepsis, trauma induced coagulopathy, malignancies
Abstract
Hemostasis represents an equilibrium between procoagulant and anticoagulant processes, but once this balance is shifted to one side, it leads to coagulopathy presented by pathological bleeding or thrombosis. Many conditions could cause coagulopathy. The most common are sepsis, severe traumas and malignancies. Widely used conventional coagulation tests (CCTs), focused only on clot initiation, are primary used to detect hypocoagulability. Viscoelastographic tests (VET), like rotational thromboelastometry (ROTEM) are whole blood tests, can detect problems in different stages of coagulation, from initiation thought clot elongation and propagation, to the clot lysis and might reveal both, hypercoagulability and hypocoagulability. ROTEM have gained popularity in the care of patients with TIC, as tool to guide transfusion support. Nowadays it is widely used in other medical specialties, too. Several studies in septic patients pointed out hypocoagulable ROTEM pattern as a predictor of poor prognosis. Additionally, there is great interest of ROTEM usage in malignancies, although limited research is currently available, it suggests ROTEM have ability to identify a patient in high risk of thrombosis. Further investigations trough randomized studies are needed to confirm ROTEM utility and to help in making a consensus about its use in different medical occasions.
References
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30. Burley K, Salem J, Phillips T, Reilly-Stitt C,Marks DI, Tunstall O. et al. Evaluation of coagulopathy before and during induction chemotherapy for acute lymphoblastic leukaemia, including assessment of global clotting tests. Blood Cancer J. 2017 Jun;7(6): e574.
31. David S, Mathews V. Mechanisms and management of coagulopathy in acute
promyelocytic leukemia. Thromb Res. 2018 Apr;164 Suppl 1:S82-S88.
32. Lehmann S, Ravn A, Carlsson L, Antunovic P, Deneberg S, Möllgård L. et al. Continuing high early death rate in acute promyelocytic leukemia: a population-based report from the Swedish Adult Acute Leukemia Registry. Leukemia. 2011 Jul;25(7):1128-34.
2. Walsh M, Moore EE, Moore H, Thomas S, Lune SV, Zimmer D. et al. Use of Viscoelastography in Malignancy-Associated Coagulopathy and Thrombosis: A Review. Semin Thromb Hemost. 2019 Jun;45(4):354-372.
3. Ganter MT, Hofer CK. Coagulation monitoring: current techniques and clinical use of viscoelastic point-of-care coagulation devices. Anesth Analg.2008 May;106(5):1366-75.
4. Tanaka KA, Bolliger D, Vadlamudi R, Nimmo A. Rotational thromboelastometry (ROTEM)-based coagulation management in cardiac surgery and major trauma. J Cardiothorac Vasc Anesth. 2012 Dec;26(6):1083-93.
5. Luddington RJ. Thrombelastography/thromboelastometry. Clin Lab Haematol. 2005: Apr;27(2):81-90.
6. Spahn DR, Rossaint R. Coagulopathy and blood component transfusion in trauma. Br J Anaesth. 2005 Aug;95(2):130-9.
7. Rugeri L, Levrat A, David JS, Delecroix E, Floccard B, Gros A. et al. Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography. J Thromb Haemost. 2007 Feb;5(2):289-95.
8. Petros S. Trauma-Induced Coagulopathy. Hamostaseologie. 2019 Feb;39(1):20-27.
9. Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019 Mar 27;23(1):98.
10. Davenport R, Manson J, De'Ath H, Platton S, Coates A, Allard S. et al. Functional definition and characterization of acute traumatic coagulopathy. Crit Care Med. 2011 Dec;39(12):2652-8.
11. Woolley T, Midwinter M, Spencer P, Watts S, Doran C, Kirkman E. Utility of
interim ROTEM (®) values of clot strength, A5 and A10, in predicting final
assessment of coagulation status in severely injured battle patients. Injury.
2013 May;44(5):593-9.
12. Raza I, Davenport R, Rourke C, Platton S, Manson J, Spoors C. et al. The
incidence and magnitude of fibrinolytic activation in trauma patients. J Thromb
Haemost. 2013 Feb;11(2):307-14.
13. Abdelfattah K, Cripps MW. Thromboelastography and Rotational Thromboelastometry use in trauma. Int J Surg. 2016 Sep;33(Pt B):196-201.
14. Schöchl H, Nienaber U, Hofer G, Voelckel W, Jambor C, Scharbert G. et al. Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM)-guided administration of fibrinogen concentrate and prothrombin complex concentrate. Crit Care. 2010;14(2):R55.
15. Iba T, Levy JH, Raj A, Warkentin TE. Advance in the Management of Sepsis-Induced Coagulopathy and Disseminated Intravascular Coagulation. J Clin Med. 2019 May 22;8(5):728.
16. Scărlătescu E, Lancé MD, White NJ, Tomescu DR. Thromboelastometric prediction of mortality using the kinetics of clot growth in critically ill septic patients. Blood Coagul Fibrinolysis. 2018 Sep;29(6):533-539.
17. Davies GR, Lawrence M, Pillai S, Mills GM, Aubrey R, Thomas D. et al. The effect of sepsis and septic shock on the viscoelastic properties of clot quality and mass using rotational thromboelastometry: A prospective observational study. J Crit Care. 2018 Apr;44:7-11.
18. Koami H, Sakamoto Y, Ohta M, Goto A, Narumi S, Imahase H. et al. Can rotational thromboelastometry predict septic disseminated intravascular coagulation? Blood Coagul Fibrinolysis. 2015 Oct;26(7):778-83.
19. Kander T, Larsson A, Taune V, Schött U, Tynngård N. Assessment of Haemostasis in Disseminated Intravascular Coagulation by Use of Point-of-Care Assays and Routine Coagulation Tests, in Critically Ill Patients; A Prospective Observational Study. PLoS One. 2016 Mar 9;11(3):e0151202.
20. Falanga A, Marchetti M, Vignoli A. Coagulation and cancer: biological and clinical aspects. J Thromb Haemost. 2013 Feb;11(2):223-33.
21. Khorana AA, Connolly GC. Assessing risk of venous thromboembolism in the patient with cancer. J Clin Oncol. 2009 Oct 10;27(29):4839-47.
22. Davies NA, Harrison NK, Sabra A, Lawrence MJ, Noble S, Davidson SJ. Et al. Application of ROTEM to assess hypercoagulability in patients with lung cancer. Thromb Res. 2015 Jun;135(6):1075-80.
23. Blasi A, Molina V, Sanchez-Cabús S, Balust J, Garcia-Valdecasas JC, Taura P. Prediction of thromboembolic complications after liver resection for cholangiocarcinoma: is there a place for thromboelastometry? Blood Coagul Fibrinolysis. 2018 Jan;29(1):61-66.
24. Thorson CM, Van Haren RM, Ryan ML, Curia E, Sleeman D, Levi JU et al. Persistence of hypercoagulable state after resection of intra-abdominal malignancies. J Am Coll Surg. 2013 Apr;216(4):580-9; discussion 589-90.
25. Hincker A, Feit J, Sladen RN, Wagener G. Rotational thromboelastometry predicts thromboembolic complications after major non-cardiac surgery. Crit Care. 2014 Oct 8;18(5):549.
26. Akay OM, Ustuner Z, Canturk Z, Mutlu FS, Gulbas Z. Laboratory investigation of hypercoagulability in cancer patients using rotation thrombelastography. Med Oncol. 2009;26(3):358-64.
27. Kekre N, Connors JM. Venous thromboembolism incidence in hematologic malignancies. Blood Rev. 2019 Jan;33:24-32.
28. Rupa-Matysek J, Gil L, Kaźmierczak M, Barańska M, Komarnicki M. Prediction of venous thromboembolism in newly diagnosed patients treated for lymphoid malignancies: validation of the Khorana Risk Score. Med Oncol. 2017 Dec 4;35(1):5.
29. Mirza AS, Yun S, Ali NA, Shin H, O'Neil JL, Elharake M. et al. Validation of the Khorana score in acute myeloid leukemia patients: a single-institution experience. Thromb J. 2019 Jul 2;17:13.
30. Burley K, Salem J, Phillips T, Reilly-Stitt C,Marks DI, Tunstall O. et al. Evaluation of coagulopathy before and during induction chemotherapy for acute lymphoblastic leukaemia, including assessment of global clotting tests. Blood Cancer J. 2017 Jun;7(6): e574.
31. David S, Mathews V. Mechanisms and management of coagulopathy in acute
promyelocytic leukemia. Thromb Res. 2018 Apr;164 Suppl 1:S82-S88.
32. Lehmann S, Ravn A, Carlsson L, Antunovic P, Deneberg S, Möllgård L. et al. Continuing high early death rate in acute promyelocytic leukemia: a population-based report from the Swedish Adult Acute Leukemia Registry. Leukemia. 2011 Jul;25(7):1128-34.