|
| Clinical settings | Study population and blood sample | TEG and ROTEM methods | Results | Ref. |
|
| FF TEG |
|
| Trauma | A randomized controlled trial of trauma patients at risk of significant hemorrhage (n=45, ISS=18-29) receiving either 6 g fibrinogen concentrate (RiaSTAP™) or placebo (normal saline). Citrated whole blood was collected from the randomized trauma patients at admission, 1-, 3-, 11-, 23- and 47-h post-infusion time. | Standard FF TEG was performed on a computerized TEG Hemostasis System 5000 (Haemonetics Corporation, Haemoscope Division, Niles, IL, USA) according to manufacturer’s protocol. Specifically, 500 μL of the blood sample was pipetted into a FF vial which contains lyophilized tissue factor with platelet inhibitor (abciximab) and gently mixed by inversion five times, and then 340 μL of the mixture from the FF vial was added into a TEG cup pre-warmed to 37°C containing 20 μL of 0.2 M calcium chloride. Plasma fibrinogen levels were measured by the standard von Clauss method. | FF TEG MA strongly correlated with Clauss fibrinogen concentration determined by Spearman’s correlation (ρ=0.75, p<0.001). FF TEG K, Alpha showed moderate correlations with fibrinogen concentration (ρ=-0.46 and 0.40, p<0.001), while TEG FF CL30 only showed week correlations with fibrinogen concentration (ρ=0.21, p=0.004). | [30, 31] |
| A prospective observational study of trauma patients (n = 68), with a median ISS of 23.5. Citrated whole-blood samples were obtained from the patients on arrival to the emergency department and within the first 5 days of admission to the surgical intensive care unit. | The FF and kaolin TEG assays were performed on the TEG 5000 device in the trauma research laboratory. The FF TEG assay measures the FF level (FLEV), which is extrapolated from the MA fibrinogen value. Plasma fibrinogen levels were measured by the standard von Clauss method. | Significant correlations between TEG FLEV and Clauss fibrinogen levels (R2 = 0.87, p<0.0001) and between TEG FF MA and Clauss fibrinogen levels (R2 = 0.75, p<0.0001). Moderate inverse correlation between FLEV and K (R2 = 0.35, p<0.0001), between FLEV and alpha (R2 = 0.70, p<0.0001). | [32] |
| A prospective observational study of 251 critically injured trauma patients with a median ISS of 9 (1-19) at a single Level 1 trauma center. Citrated whole blood was collected from the patients on arrival and at 2, 3, 4, 6, 12, 24, 48, 72, 96, and 120 h after admission. | For the kaolin TEG, 340 μL kaolin-activated blood was transferred to the TEG cup, pre-warmed to 37°C and containing 20 μL of 0.2 M CaCl2. For the FF TEG, 500 μL of citrated blood was added to the FF vial (kaolin + glycoprotein IIb/IIIa antagonist) and mixed; 340 μL was then transferred to the TEG cup. Plasma fibrinogen concentration was assayed by the von Clauss method. | FLEV calculated by analytical software through a transformation of the FF MA to approximate the concentration of functional fibrinogen correlates with standard Clauss fibrinogen (R2= 0.57, p<0.001), similar to MA (R2=0.44-0.64, p<0.001) better than the kaolin TEG measures of fibrinogen function (kinetic time and angle) (R2=0.01, p=0.095; and R2=0.03, p=0.004) | [33] |
| A prospective observational study of 182 trauma patients with a median ISS of 17 (9-26). Citrated blood was sampled immediately upon arrival. | The FF TEG with tissue factor activator and a platelet inhibitor (ReoPro, a GPIIb/IIIa inhibitor) was performed by a TEG 5000 Hemostasis Analyzer System using TEG Analytical Software version 4.2.3 (Haemonetics Corp., Braintree, MA), according to the manufacturer’s recommendations. | FF TEG MA, A5, A10 had moderate correlation with fibrinogen concentration determined by Spearman’s correlation (ρ=0.64, 0.68, 0.68, p<0.01). | [34, 35] |
|
| Cardiac surgery | A prospective observational study of 117 patients operated for ischemic heart disease. Blood was collected before cardiopulmonary bypass | FF TEG test was conducted using functional fibrinogen reagent (lyophilized tissue factor with platelet inhibitor- glycoprotein-IIb/IIIa receptor blocker). Analytical software calculated the functional fibrinogen level (FLEV) through the transformation of the MA value. Fibrinogen levels were assessed by the von Clauss method. | A moderate correlation was found between fibrinogen level and FF TEG FLEV with a Spearman correlation coefficient of 0.476 (p<0.0001). | [36] |
| A prospective study of 160 cardiac surgery patients. Blood was collected at baseline, prior to heparinisation and 10 min post protamine administration | TEG-functional fibrinogen test was conducted with native blood using the functional fibrinogen reagent (lyophilized tissue factor with platelet inhibitor- glycoprotein IIb/IIIa receptor blocker). Analytical software calculates the functional fibrinogen level (FLEV) through the transformation of the MA value. Fibrinogen levels were assessed with citrated blood by the von Clauss method using Fibrinogen-CXL (HemosiL; Instrumentation Laboratory, Bedford, MA, USA) performed on the ACL TOP 300 CTS analyser (Instrumentation Laboratory, Bedford, MA, USA). | No significant correlation between the TEG FLEV and the Clauss fibrinogen level at the baseline (R2=0.106) and 10 min post protamine (R2=0.025) and between the TEG FF MA and the Clauss fibrinogen concentration at the baseline (R2=0.061) and 10 min post protamine (R2=0.26) | [37] |
| A prospective study of 60 elective patients operated for ischemic heart disease with CPB and randomly assigned to a group with a heparin-coated CPB system or a group with a conventional (non-coated) circuit. Blood was collected from right after induction of general anesthesia, 2-h post operation, and second postoperative day. | FF TEG test was conducted by modified TEG with platelet inhibition (Haemoscope Corporation, Niles, IL, USA). Plasma fibrinogen levels were determined by a Clauss method not specified. | Spearman’s correlation analysis showed a moderately positive correlation between perioperative Clauss fibrinogen level and FF TEG MA (n=60, r=0.408, p=0.002) | [38] |
| A prospective non-randomized study of 51 cardiac surgery patients. Citrated (3.2%) blood collection tubes were used for all samples 3 time points: (1) baseline; (2) rewarming on cardiopulmonary bypass; (3) post bypass. | FLEV assays were determined by TEG 5000 hemostasis analyzers in accordance with company’s protocol utilizing the provided functional fibrinogen reagent vials (heparinase cups were used for all bypass samples). Plasma fibrinogen levels were measured using the Clauss method (TriniCLOT Fibrinogen Kit with Destiny Max Coagulation Analyzer; Tcoag, Bray, Ireland). | A simple linear regression model showed a strong correlation between the standard laboratory assay (Clauss) and the functional fibrinogen level (FLEV) assay (r = 0.76; p<0.0001) of the fibrinogen values at the baseline. Similar correlation was seen at the rewarming and post bypass. FLEV values were consistently higher than the standard laboratory assay. | [39] |
| A prospective observational study of 105 children less than 5 years of age undergoing congenital heart surgery with CPB. Citrated blood was collected before and after bypass. | FF TEG was performed on the TEG 5000 hemostasis analyzers with functional fibrinogen reagent vial and heparinase TEG cup (Haemonetics, Niles, IL) by a single technician, within 20 min of collection of the samples. Fibrinogen levels were determined by the Clauss method on platelet-poor, centrifuged blood samples (STA Fibrinogen, Diagnostica Stago). | Linear correlation coefficients between FF TEG MA and fibrinogen levels were 0.36 (p<0.001) before and 0.52 after bypass (p=0.02). | [40] |
| A retrospective and observational study of 119 children younger than 10 years old undergoing congenital cardiac surgery with CPB. Blood was collected twice during surgery, after anesthesia induction and CPB. | ROTEM FIBTEM was performed according to manufacturer’s procedure. Fibrinogen concentration was measured by a fully automated device (Diagnostica Stago, Asnières, France). | Post-CPB fibrinogen levels were not correlated with post-CPB FIBTEM MCF in infants (r=0.155, p=0.197, 0.155), whereas they were correlated with FIBTEM MCF in children older than 12 months (r=0.311, p=0.031). | [41] |
|
| Liver transplantation (LT) | A prospective study of 27 consecutive adult LT patients. Blood sample was taken from an arterial line at the time of the skin incision (the baseline) and 30 min after graft reperfusion | The whole blood was analyzed with TEG 5000 hemostasis analyzer according to the manufacturer’s instructions. Plasma fibrinogen level were measured with a modified Clauss method using a coagulation analyzer (STA-R Evolution Expert series hemostasis system, Diagnostica Stago, Parsippany, NJ, USA) | FF TEG MA correlated strongly with the plasma fibrinogen level at the baseline (Spearman’s correlation coefficient ρ=0.90, p<0.01); however, the correlation reduced after the graft reperfusion (ρ=0.58, p<0.01). The same correlations were seen between FF TEG FLEV and the plasma fibrinogen level. | [42] |
|
| Pregnancy | A prospective study of 21 healthy, term parturients scheduled for elective cesarean delivery. Fresh whole blood was drawn from each patient. | Modified TEG was performed with 360 mL of 1% celite-activated whole blood and with 5 mL of (2mg/mL) ReoPro® (platelet aggregation inhibitor) added to 355 mL of 1% celite-activated whole blood within 4 min of blood collection. The plasma fibrinogen concentration was measured by the Clauss quantitative fibrinogen assay using thrombin derived from bovine plasma (Ortho Diagnostic System Inc., Raritan, NJ). | Linear regression analysis revealed TEG MA as a significant predictor of the plasma fibrinogen level, with an adjusted R2 of 0.49, and a slope of fibrinogen level= 9.56×MA + 150.68 | [43] |
|
| ROTEM FIBTEM |
|
| Trauma | Randomized controlled trial of trauma patients at risk of significant hemorrhage (n=45, ISS=18-29) receiving either 6 g fibrinogen concentrate (RiaSTAP™) or placebo (normal saline). Citrated whole blood was collected from the randomized trauma patients at admission, 1-, 3-, 11-, 23- and 47-h post-infusion time. | Standard ROTEM FIBTEM was performed on a ROTEM delta system according to manufacturer’s protocol. Specifically, analyses were performed using 300 μL of citrated whole blood and 20 μL of ex-tem together with 20 μL of fib-tem following the procedure as recommended by the company. Plasma fibrinogen levels were measured by the standard von Clauss method. | ROTEM FIBTEM MCF strongly correlated with Clauss fibrinogen concentration determined by Spearman’s correlation (ρ=0.87, p<0.001). ROTEM FIBTEM CFT, Alpha showed moderate correlations with fibrinogen concentration (ρ=-0.41 and 0.54, p<0.001), while CT and LI30 weekly correlated with fibrinogen concentration (ρ=-0.29, p<0.001 and 0.20, p=0.003). | [30, 31] |
| A prospective study of 517 adult trauma patients with a systolic blood pressure (SBP) of < 90 mmHg and a median ISS of 14 (8–27). Citrated blood was collected within 20 min of arrival in the emergency department (ED). | Blood samples were analyzed within 2 h of blood draw, with a ROTEM delta instrument, at 37°C. Two separate ROTEM assays were performed for each patient, the EXTEM, measuring tissue factor-initiated clotting, and the FIBTEM, with the addition of cytochalasin D, a platelet inhibitor as per manufacturer’s protocols. Fibrinogen levels were determined with the Clauss method using STA Fibrinogen (Stago, Asnières sur Seine, France) and Siemens Thrombin (Sysmex UK, Milton Keynes, UK) reagents. | EXTEM and FIBTEM measures of A5 and maximal clot formation (MCF) were significantly correlated with Clauss fibrinogen levels, and the correlations between FIBTEM A5 and MCF were slightly stronger than EXTEM (r2 = 0.44 vs. 0.35 and 0.27 vs. 0.26). EXTEM and FIBTEM A5 gave a receiver operating characteristic curve area of 0.8 (95% confidence interval 0.7–0.9, p<0.001) for discriminating patients with admission fibrinogen levels below 1.5 g/L. | [3] |
| A retrospective study of 358 trauma patients with a median ISS of 26 (17–34). Citrated blood was collected at admission and during the first 12-h care. | EXTEM and FIBTEM were performed in a standardized fashion within 30 min of blood collection. Fibrinogen concentration was measured by the Clauss technique, STA-Fibrinogen. | Correlations between fibrinogen concentration and FIBTEM A5 at admission (Spearman coefficient ρ=0.858) and during care (ρ=0.824), no blood product group (ρ=0.772) and blood product group (ρ=0.823). | [44] |
| A prospective observational cohort study of 182 trauma patients with a median ISS of 17 (9 to 26). Blood was sampled immediately upon arrival at hospital and kept at room temperature. | EXTEM, INTEM and FIBTEM assays were performed with citrated blood according to the manufacturer’s recommendations 1 h after sampling. | Fibrinogen concentration had moderate correlations with A5, A10 and MCF of EXTEM (ρ=0.65-0.68), INTEM (ρ=0.62-0.68) and FIBTEM (ρ=0.68). | [34] |
| A prospective observational study of 88 trauma patients with an ISS of 22 (12-34). Blood samples were collected immediately after the patient’s arrival to the trauma room and at 6, 12 and 24 h after admission | EXTEM, INTEM and FIBTEM were performed at 37°C in parallel with the citrated blood within 2 h and after 15 min of collection in a standardized way. Fibrinogen levels were assayed according to Clauss technique using Fibriquick® reagent (Biomérieux). | A significant correlation was found between fibrinogen levels and EXTEM CT (r = 0.40, p<0.001), A15 (r=0.69, p<0.001), between fibrinogen levels and INTEM A15 (r=0.66, p<0.001), and between fibrinogen levels and FIBTEM A10 (r=0.85, p<0.001) | [45] |
| A prospective cohort study of 334 blunt trauma patients (ISS≥15 or Glasgow Coma Score ≤14). Citrated blood was collected at hospital admission. | ROTEM EXTEM and FIBTEM tests were performed according to manufacturer’s guides. Plasma fibrinogen concentration was measured using test kits from Siemens Healthcare AG, Erlangen, Germany. | EXTEM and FIBTEM MCF showed strong correlations with fibrinogen concentration (ρ=0.79 and 0.81, respectively, p<0.001). | [46] |
|
| Cardiac surgery | A prospective, observational pilot study of 35 patients undergoing elective cardiac surgery on cardiopulmonary bypass for cyanotic congenital heart disease. Blood samples were collected after induction of anesthesia. | EXTEM, INTEM and FIBTEM were performed with citrated blood after recalcification with 20 μL CaCl2. Fibrinogen concentration assay was not provided. | Fibrinogen concentration showed a significant correlation with ROTEM FIBTEM MCF (Pearson coefficient r=0.94, p< 0.001), but not with EXTEM MCF (r=0.077, p=0.67) and INTEM MCF (r=0.162, p=0.37). | [47] |
| A prospective observational study of 30 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Citrated blood was drawn at the beginning of surgery (pre-CPB), 20 minutes before weaning from CPB and 5 minutes after heparin neutralization. | TEG with the functional fibrinogen reagent (FF TEG), ROTEM with fib-tem (FIBTEM) and fib-tem plus containing two platelet inhibitors: cytochalasin D and tirofiban (FIBTEM PLUS) were run for a minimum of 30 min. Fibrinogen concentration was measured using the Clauss method and photo-optical determination on the ACL Top 700 (Instrumentation Laboratory, Milan, Italy) and QFA thrombin reagent (Instrumentation Laboratory). | Significant positive correlations were found between MCF or MA and fibrinogen concentration (all p<0.001); the highest correlation was with FIBTEM PLUS MCF (Spearman coefficient ρ=0.70), followed by FIBTEM (ρ=0.66) and FF TEG (ρ=0.56). | [48] |
| A prospective study of 157 patients undergoing cardiac surgery with CPB. Citrated blood were collected at baseline (before induction of anaesthesia) and at the end of CPB (after protamine administration). | Whole blood FIBTEM was performed using a ROTEM device according to the manufacturer's instructions at each time point. Plasma fibrinogen concentration was measured using the Clauss method and whole blood fibrinogen concentration was calculated as plasma fibrinogen concentration × (100 − haematocrit)/100. | The Spearman correlation coefficient between FIBTEM MCF and plasma fibrinogen concentration was 0.68 at baseline and 0.70 after protamine, while that between FIBTEM MCF and whole blood fibrinogen concentration was 0.74 at baseline and 0.72 after protamine (all p<0.001). | [49] |
| A prospective observational study of 35 patients undergoing elective cardiac surgery with CPB. Citrated blood was collected from at three different time points: preoperatively (immediately before anesthesia induction), and at 1- and 24-h post operation. | Kaolin TEG and ROTEM EXTEM, INTEM, FIBTEM were conducted with the citrated blood within 1 h after the collection, according to the manufacturer’s instructions. Fibrinogen concentration was measured by a standard method (not specified). | Correlations between fibrinogen concentration and EXTEM MCF (Pearson coefficient r=0.71, p<0.0005), INTEM MCF (r=0.53, p=0.001), FIBTEM MCF (r=0.79, p<0.0005) were found at 1-h post operation and correlations between fibrinogen concentration and TEG K (r=-0.52, p=0.002), Alpha (r=0.53, p=0.001), TEG MA (r=0.63, p<0.0005), EXTEM MCF (r=0.58, p=0.001), INTEM MCF (r=0.63, p<0.0005), FIBTEM (r=0.50, p=0.003) at 24-h post operation. | [50] |
| A retrospective observational study of 1077 patients undergoing cardiac surgery with CPB. Citrated blood was collected during the rewarming phase (≥36°C). | EXTEM and FIBTEM were conducted at 37°C as per manufacturer’s reagents and procedures. Fibrinogen concentration was measured by the Clauss method using STAR Evolution (Stago, Paris, France). | Clauss fibrinogen concentration was correlated strongly with EXTEM MCF and A10 (Spearman coefficient ρ=0.68 and 0.70; p<0.01) and FIBTEM MCF and A10 (ρ=0.78 and 0.78; p<0.01). The correlation was related inversely to hemoglobin concentration (p< 0.01). | [51] |
| A randomized controlled trial of 116 high-risk patients undergoing cardiac surgery with CPB. Blood was collected at 20 min before removal of the aortic cross-clamp (baseline) and after placebo or fibrinogen administration. | FIBTEM test was conducted. Fibrinogen concentrations were measured according to a photo-optical Clauss method, with a coagulation analyser (ACL TOP 700), a calibrator (Hemosil Normal Control), and a thrombin reagent (Hemosil QFA thrombin). | Linear regression analyses showed a good association between FIBTEM MCF and Clauss fibrinogen concentration at the baseline population (R2=0.66, p=0.001), which reduced to R2=0.16 (p=0.003) in fibrinogen-supplemented subjects. | [52] |
| A prospective observational study of 110 patients undergoing cardiac surgery with CPB. Citrated whole blood was sampled from a central venous line or from the extracorporeal circuit at pre-CPB, on-CPB, post-CPB. | ROTEM assays of INTEM, EXTEM, FIBTEM and HEPTEM were performed at 37°C by certified bioanalytical technicians.
Plasma levels of fibrinogen were measured using the Clauss technique on a coagulation analyzer (BCS, Dade Behring Inc., Germany) using the Multifibren U-Reagent according to manufacturer’s specifications. | The fibrinogen level and FIBTEM A10 were significantly correlated for all data points (Pearson coefficient r=0.81; p<0.05). Their correlation was stronger on-CPB at a mean hemoglobin of 83 g/L (r= 0.87) and post-CPB (mean hemoglobin 88 g/L; r=0.74) than pre-CPB (mean Hemoglobin 105 g/L; r=0.66). | [53] |
|
| Liver transplantation (LT) | A retrospective observational study of 282 patients receiving liver transplantation. Citrated blood was collected at 1 h after induction of general anesthesia, 1 h after the first surgical incision, 30 min after hepatectomy, 30 min after graft reperfusion, and after hepatic artery anastomosis. | ROTEM tests (EXTEM, INTEM and FIBTEM) were routinely performed according to the manufacturer’s instructions. Fibrinogen concentration was measured using the Dade thrombin reagent (Siemens Healthcare Diagnostics, Erlangen, Germany) and an automatic coagulation analyzer (Sysmex CA-7000, Siemens Healthcare Diagnostics, Erlangen, Germany). | Fibrinogen was the primary determinant of FIBTEM MCF, accounting for 73% of the variability. However, in severe hypofibrinogenemia (fibrinogen <1 g/L), fibrinogen accounted only 22% of FIBTEM MCF variability. Spearman’s correlations between fibrinogen concentration and EXTEM MCF (ρ=0.66, p<0.001), INTEM MCF (ρ=0.65, p<0.001), FIBTEM MCF (ρ=0.83, p<0.001). | [54] |
| A retrospective observational study of 295 patients (254 living donors and 41 LT patients). Citrated blood was collected from 1 h after induction of general anesthesia, 1 h after surgical incision, 30 min after hepatectomy, 30 min after graft reperfusion, and after hepatic artery anastomosis. | The same as above | FIBTEM MCF significantly correlated with fibrinogen concentration with a highest Spearman’s coefficient (ρ = 0.84, p<0.001), followed by EXTEM MCF (ρ=0.67, p<0.001), INTEM MCF (ρ=0.66, p<0.001). | [55] |
| A prospective study of 253 patients receiving orthotopic liver transplantation. Citrated blood samples were collected after induction of general anesthesia, at the end of the hepatectomy, 20 minutes after graft revascularization, and 90 minutes after graft revascularization. | The blood samples were tested just after collection by ROTEM gamma device operated according to manufacturer instructions and with the type and concentration of reagents as provided by Pentapharm (Munich, Germany). Fibrinogen concentration was measured by prothrombin time-derived method, with values below 2 g/L being checked by the Clauss method on a coagulometer (KC-1A, Amelung, Lemgo, Germany) using fibrinogen reagent (Diagnostica Stago, Asnières, France) according to the manufacturer’s instructions. | FIBTEM MCF correlated with fibrinogen level (Spearman’s correlation coefficient ρ=0.70). | [56] |
| A prospective observational study of 20 patients undergoing orthotopic liver transplantation. Blood samples were taken at the following points during OLT: the beginning of the dissection phase, the end of dissection phase, 10 min into the anhepatic phase, 10 min into the reperfusion phase, and 1 h after donor graft reperfusion. | FIBTEM was performed with citrated blood within 4 h of collection according to the manufacturer’s instructions. Clauss fibrinogen assay was performed on a CA-1500 analyzer (Sysmex, Milton Keynes, UK). | There was a significant correlation between FIBTEM MCF and Clauss fibrinogen concentration (Pearson’s correlation coefficient r =0.75, p≤0.01). | [23] |
| A prospective observational study of 23 patients undergoing orthotopic liver transplantation. Blood samples were collected after induction of general anaesthesia, during hepatectomy, at the anhepatic stage, 30–60 min after graft revascularization, at the end of surgery, and 24 h after surgery | ROTEM tests (EXTEM, INTEM, FIBTEM and APTEM) were performed in the operating theatre and by the anaesthesiologists treating the patients according to the manufacturer’s instructions using equipment and test reagents provided by Pentapharm GmbH. Plasma fibrinogen concentration was determined by the Clauss method performed on ACL Top automates (Instrumentation Laboratory, Lexington, MA, USA) | ROTEM FIBTEM A10 correlated with Clauss fibrinogen (r=0.74, p<0.0001), only slightly stronger than EXTEM A10 (r=0.72, p<0.0001) | [57] |
|
| | A retrospective study of 401 patients who underwent liver transplantation. Blood was sampled at 1 h after induction of general anaesthesia, 1 h after surgical incision, 30 min after hepatectomy, and 30 min after graft reperfusion and after hepatic artery anastomosis. | ROTEM tests were performed according to the manufacturer’s instructions, using equipment and test reagents
provided by Tem International GmbH. Fibrinogen level was measured using the Dade Thrombin Reagent (Siemens Healthcare Diagnostics) and an automatic
coagulation analyser (Sysmex CA-7000, Siemens Healthcare Diagnostics). | The correlations of FIBTEM A5, A10, MCF with fibrinogen levels were determined using Spearman’s rank correlation coefficients (ρ= 0.75, 0.76 and 0.75, respectively, p<0.001). | [58] |
|
| Postpartum | A prospective observational study of 91 women at the third trimester of pregnancy: 37 with postpartum haemorrhage (study group) and 54 without abnormal bleeding (control group). Citrated blood was collected from women at the third trimester of pregnancy. | Standard FIBTEM was carried out by clinicians with the blood samples in the delivery room. Fibrinogen assay was for plasma concentration within 5 min after sampling with a STAR automated coagulation analyser (Diagnostica Stago Inc., Franconville, France) | A5, A15 and MCF were significantly lower in the haemorrhage group than in control (p<0.0001) and strongly correlated with fibrinogen levels both groups (Spearman’s correlation coefficient ρ= 0.84–0.87, p<0.0001). | [59] |
|
| Neurosurgery | A prospective observational study of 92 patients undergoing emergent neurosurgery | ROTEM analyses were performed within min of blood sampling by anesthesia nurses or physicians trained to perform the ROTEM tests according to the manufacturer’s instructions. Plasma fibrinogen concentration was determined by Clauss method (Siemens-Dade Behring Healthcare Diagnostics, Marburg, Germany). | There was a strong correlation between PTT and INTEM
CT (r=0.76) as well as between fibrinogen concentrations and FIBTEM MCF (r =0.70). | [60] |
|
| Burn injury | A prospective observational study of 20 consecutive patients. Citrated blood was collected immediately after admission, 12, 24 and 48 h after admission. | Four ROTEM tests (INTEM, EXTEM, FIBTEM and APTEM) were performed simultaneously on the four-channel ROTEM in the ICU ward lab at each time point. Plasma fibrinogen level was determined by Clauss method using an automated coagulation analyzer (STA-R Evolution, Stago, Asnières, France). | Fibrinogen level and FIBTEM
MCF were within the reference range until 24 h after burn injury, but increased significantly after 48 h. There was a significant correlation between FIBTEM MCF and fibrinogen level (Spearman’s correlation coefficient ρ = 0.714, p <0.001). | [61] |
|
| Cirrhosis | A cross-sectional single-centre study involving 60 patients with alcoholic cirrhosis, 24 patients with cholestatic cirrhosis and a control group of 50 healthy volunteers. Blood samples were taken at admission. | ROTEM FIBTEM assay was performed with citrated blood within 1 h after collection using a set of standard reagents according to the manufacturer’s recommendations. Clauss fibrinogen assay was performed using a BCS® XP automated coagulation analyzer (Siemens Healthcare Diagnostics GmbH, Marburg, Germany). | In all cirrhosis patients, FIBTEM MCF strongly correlated with fibrinogen concentration (r=0.72-0.77, p< 0.001). | [62] |
|
