Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Feb;41(1):49-56.
doi: 10.1007/s00068-014-0400-0. Epub 2014 Apr 4.

Viscoelastic hemostatic fibrinogen assays detect fibrinolysis early

J N Harr  1 , E E Moore, T L Chin, M P Chapman, A Ghasabyan, J R Stringham, A Banerjee, C C Silliman
Affiliations

Viscoelastic hemostatic fibrinogen assays detect fibrinolysis early

J N Harr et al. Eur J Trauma Emerg Surg. 2015 Feb.

Abstract

Purpose: Viscoelastic hemostatic assays are emerging as the standard-of-care in the early detection of post-injury coagulopathy. TEG and ROTEM are most commonly used. Although similar in technique, each uses different reagents, which may affect their sensitivity to detect fibrinolysis. Therefore, the purpose of this study is to determine the ability of each device to detect fibrinolysis.

Methods: TEG (Rapid, Kaolin, Functional Fibrinogen) and ROTEM (EXTEM, INTEM, FIBTEM) were run simultaneously on normal blood as well as blood containing tPA from healthy volunteers (n = 10). A two-tailed, paired t-test and ANOVA were used to determine the significance between parameters obtained from normal blood and blood with tPA, and individual TEG and ROTEM assays, respectively.

Results: TEG detected significant changes in clot strength and 30-min lysis after the addition of tPA (p < 0.0001). All ROTEM assays detected changes in the 30-min lysis (p < 0.0001), but only INTEM detected changes in clot strength (p < 0.05). Kaolin and Rapid TEG assays detected greater changes in clot strength and lysis, but INTEM and EXTEM had decreased lysis onset times compared to TEG (p < 0.001). Functional Fibrinogen and FIBTEM assays detected lysis sooner than other TEG/ROTEM assays, and were comparable.

Conclusions: TEG assays detect greater changes in clot strength compared to ROTEM. Despite this, Functional Fibrinogen and FIBTEM assays detect fibrinolysis sooner than their corresponding intrinsic and extrinsic assays. Therefore, fibrinogen assays should be employed in actively bleeding trauma patients in order to provide timely antifibrinolytic therapy.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest J. N. Harr, E. E. Moore, T. L. Chin, M. P. Chapman, A. Ghasabyan, J. R. Stringham, A. Banerjee, and C. C. Silliman report no conflict of interest.

Figures

Fig. 1
Fig. 1
Mechanisms involved in trauma-induced coagulopathy (TIC)
Fig. 2
Fig. 2
Parameters for both TEG (a) and ROTEM (b)
Fig. 3
Fig. 3
Clot strengths (MA) and lysis (CL30) parameters for Kaolin, Rapid, and Functional Fibrinogen TEG assays without and with the addition of tPA. All clot strengths (p < 0.01) and lysis parameters (p < 0.0001) had a significant decrease, demonstrating significant lysis
Fig. 4
Fig. 4
Clot strengths (MCF) and lysis (LI30) parameters for INTEM, EXTEM, and FIBTEM ROTEM assays without and with the addition of tPA. Only the INTEM clot strength had a significant decrease following the administration of tPA (p < 0.05). All lysis parameters had a significant decrease, demonstrating significant lysis (p < 0.001)
See this image and copyright information in PMC

References

    1. Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma. 2003;54(6):1127–30. - PubMed
    1. Plotkin AJ, Wade CE, Jenkins DH, Smith KA, Noe JC, Park MS, Perkins JG, Holcomb JB. A reduction in clot formation rate and strength assessed by thrombelastography is indicative of transfusion requirements in patients with penetrating injuries. J Trauma. 2008;64(2 Suppl):S64–8. - PubMed
    1. Maegele M, Lefering R, Yucel N, Tjardes T, Rixen D, Paffrath T, Simanski C, Neugebauer E, Bouillon B. AG Polytrauma of the German Trauma Society (DGU). Early coagulopathy in multiple injury: an analysis from the German Trauma Registry on 8724 patients. Injury. 2007;38:298–304. - PubMed
    1. MacLeod JB, Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma. 2003;55:39–44. - PubMed
    1. Brohi K, Cohen MJ, Ganter MT, Schultz MJ, Levi M, Mackersie RC, Pittet JF. Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. J Trauma. 2008;64(5):1211–7. - PubMed

Publication types

MeSH terms

LinkOut - more resources