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Herbert Schochl - One of the best experts on this subject based on the ideXlab platform.
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the effectiveness of different functional fibrinogen polymerization assays in eliminating platelet contribution to clot strength in Thromboelastometry
Anesthesia & Analgesia, 2014Co-Authors: Christoph J Schlimp, Gerald Hochleitner, Cristina Solomon, Heinz Redl, Marco Ranucci, Herbert SchochlAbstract:BACKGROUND:Viscoelastic tests such as functional fibrinogen polymerization assays (FFPAs) in thrombelastography (TEG®) or Thromboelastometry (ROTEM®) measure clot elasticity under platelet inhibition. Incomplete platelet inhibition influences maximum clot firmness (MCF) of FFPAs. We compared the abi
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the effect of fibrinogen concentrate and factor xiii on Thromboelastometry in 33 diluted blood with albumin gelatine hydroxyethyl starch or saline in vitro
Blood Transfusion, 2013Co-Authors: Christoph J Schlimp, Janne Cadamuro, Cristina Solomon, Heinz Redl, Herbert SchochlAbstract:Background Fluid replacement results in dilutional coagulopathy. We investigated the potential role of fibrinogen, factor XIII and a combination of both to reverse dilutional coagulopathy, assessed by Thromboelastometry (ROTEM ® ).
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effect of haematocrit on fibrin based clot firmness in the fibtem test
Vox Sanguinis, 2013Co-Authors: Cristina Solomon, Herbert Schochl, Niels Rahemeyer, Marco Ranucci, Klaus GorlingerAbstract:Background Point-of-care Thromboelastometry (ROTEM®) can be used to assess coagulation in whole blood. In the ROTEM® FIBTEM test, cytochalasin D eliminates the contribution of platelets to the whole blood clot; hence, only the remaining elements, including fibrinogen/fibrin, red blood cells and factor XIII, contribute to clot strength. We investigated the relationships between FIBTEM maximum clot firmness (MCF), whole blood fibrinogen concentration and plasma fibrinogen concentration to determine the impact of haematocrit on these parameters during cardiac surgery.
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Thromboelastometry (TEM ® ) Findings in Disseminated Intravascular Coagulation in a Pig Model of Endotoxinemia
2012Co-Authors: Herbert Schochl, Cristina Solomon, Wolfgang G Voelckel, Heinz Redl, Arthur Schulz, Er Hanke, Martijn Van Griensven, Soheyl BahramiAbstract:Standard coagulation tests have a low specificity and sensitivity for diagnosing disseminated intravascular coagulation. The aim of this study was to determine whether whole blood Thromboelastometry (TEM) detects lipopolysaccharide (LPS)-induced changes in coagulation. Blood samples from 10 pigs were drawn at baseline, before and at the end of LPS infusion and 2, 3, 4 and 5 h after the start of endotoxinemia. Simultaneous to TEM, standard coagulation tests and extended coagulation analysis including tissue plasminogen activator (t-PA) and plasminogen activator inhibitor 1 (PAI-1) were performed. Endotoxinemia resulted in a significant acceleration of the nonactivated TEM (NATEM) clotting time 2 h after the end of LPS infusion; in contrast, the changes in international normalized ratio and activated partial thromboplastin time suggested delayed initiation of coagulation. NATEM maximum clot firmness (MCF) and fibrin-based Thromboelastometry test (FIBTEM ®)-MCF decreased significantly from baseline until the last time point (from 64.6 ± 7.8 and 35.1 ± 12.8 mm to 52.8 ± 4.6 and 21.4 ± 11.8 mm, respectively; P = 0.01 for both parameters). A sharp, transient increase of t-PA had no effect on maximum lysis in the NATEM test. PAI-1 increased significantly 3 h after the start of LPS infusion, paralleled by a decrease in maximum lysis. In conclusion, TEM was superior to standard coagulation tests in reflecting initial activation of coagulation during endotoxinemia. TEM further suggested consumption of coagulation substrate; at the same time, inhibition of plasminogen activation was accompanied by improved clot stability. Further investigations are necessar
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comparison of whole blood fibrin based clot tests in thrombelastography and Thromboelastometry
Anesthesia & Analgesia, 2012Co-Authors: Cristina Solomon, Gerald Hochleitner, Benny Sorensen, Marco Ranucci, Jeffry Kashuk, Herbert SchochlAbstract:BACKGROUND: Fibrin-based clot firmness is measured as maximum amplitude (MA) in the functional fibrinogen (FF) thrombelastographic assay and maximum clot firmness (MCF) in the FIBTEM thromboelastometric assay. Differences between the assays/devices may be clinically significant. Our objective was to compare clot firmness parameters through standard (FF on a thrombelastography device [TEG®]; FIBTEM on a Thromboelastometry device [ROTEM®]) and crossover (FF on ROTEM®; FIBTEM on TEG®) analyses. METHODS: Whole-blood samples from healthy volunteers were subjected to thrombelastography and Thromboelastometry analyses. Samples were investigated native and following stepwise dilution with sodium chloride solution (20%, 40%, and 60% dilution). Samples were also assessed after in vitro addition of medications (heparin, protamine, tranexamic acid) and 50% dilution with hydroxyethyl starch, gelatin, sodium chloride, and albumin. RESULTS: FF produced higher values than FIBTEM, regardless of the device, and TEG® produced higher values than ROTEM®, regardless of the assay. With all added medications except heparin 400 U/kg bodyweight, FF MA remained significantly higher (P 50%. CONCLUSIONS: These results demonstrate differences when measuring fibrin-based clotting via the FF and FIBTEM assays on the TEG® and ROTEM® devices. Point-of-care targeted correction of fibrin-based clotting may be influenced by the assay and device used. For the FF assay, data are lacking.
Cristina Solomon - One of the best experts on this subject based on the ideXlab platform.
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Testing in a 24-Hour Porcine Trauma Model
2016Co-Authors: Christian Zentai, Cristina Solomon, Jonas Schnabel, Rolf Rossaint, Henri M. H. Spronk, Oliver GrottkeAbstract:Introduction: In a 24-hour porcine model of liver injury, we showed that fibrinogen supplementation does not downregulate endogenous fibrinogen synthesis. Herewe report data from the same study showing the impact of fibrinogen on coagulation variables. Materials and Methods: Coagulopathy was induced in 20 German land race pigs by hemodilution and blunt liver injury. Animals randomly received fibrinogen concentrate (100 mg/kg) or saline. Coagulation parameters were assessed and Thromboelastometry (ROTEM) was performed. Results: Fibrinogen concentrate significantly reduced the prolongations of EXTEM clotting time, EXTE
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the effectiveness of different functional fibrinogen polymerization assays in eliminating platelet contribution to clot strength in Thromboelastometry
Anesthesia & Analgesia, 2014Co-Authors: Christoph J Schlimp, Gerald Hochleitner, Cristina Solomon, Heinz Redl, Marco Ranucci, Herbert SchochlAbstract:BACKGROUND:Viscoelastic tests such as functional fibrinogen polymerization assays (FFPAs) in thrombelastography (TEG®) or Thromboelastometry (ROTEM®) measure clot elasticity under platelet inhibition. Incomplete platelet inhibition influences maximum clot firmness (MCF) of FFPAs. We compared the abi
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the effect of fibrinogen concentrate and factor xiii on Thromboelastometry in 33 diluted blood with albumin gelatine hydroxyethyl starch or saline in vitro
Blood Transfusion, 2013Co-Authors: Christoph J Schlimp, Janne Cadamuro, Cristina Solomon, Heinz Redl, Herbert SchochlAbstract:Background Fluid replacement results in dilutional coagulopathy. We investigated the potential role of fibrinogen, factor XIII and a combination of both to reverse dilutional coagulopathy, assessed by Thromboelastometry (ROTEM ® ).
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effect of haematocrit on fibrin based clot firmness in the fibtem test
Vox Sanguinis, 2013Co-Authors: Cristina Solomon, Herbert Schochl, Niels Rahemeyer, Marco Ranucci, Klaus GorlingerAbstract:Background Point-of-care Thromboelastometry (ROTEM®) can be used to assess coagulation in whole blood. In the ROTEM® FIBTEM test, cytochalasin D eliminates the contribution of platelets to the whole blood clot; hence, only the remaining elements, including fibrinogen/fibrin, red blood cells and factor XIII, contribute to clot strength. We investigated the relationships between FIBTEM maximum clot firmness (MCF), whole blood fibrinogen concentration and plasma fibrinogen concentration to determine the impact of haematocrit on these parameters during cardiac surgery.
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Thromboelastometry (TEM ® ) Findings in Disseminated Intravascular Coagulation in a Pig Model of Endotoxinemia
2012Co-Authors: Herbert Schochl, Cristina Solomon, Wolfgang G Voelckel, Heinz Redl, Arthur Schulz, Er Hanke, Martijn Van Griensven, Soheyl BahramiAbstract:Standard coagulation tests have a low specificity and sensitivity for diagnosing disseminated intravascular coagulation. The aim of this study was to determine whether whole blood Thromboelastometry (TEM) detects lipopolysaccharide (LPS)-induced changes in coagulation. Blood samples from 10 pigs were drawn at baseline, before and at the end of LPS infusion and 2, 3, 4 and 5 h after the start of endotoxinemia. Simultaneous to TEM, standard coagulation tests and extended coagulation analysis including tissue plasminogen activator (t-PA) and plasminogen activator inhibitor 1 (PAI-1) were performed. Endotoxinemia resulted in a significant acceleration of the nonactivated TEM (NATEM) clotting time 2 h after the end of LPS infusion; in contrast, the changes in international normalized ratio and activated partial thromboplastin time suggested delayed initiation of coagulation. NATEM maximum clot firmness (MCF) and fibrin-based Thromboelastometry test (FIBTEM ®)-MCF decreased significantly from baseline until the last time point (from 64.6 ± 7.8 and 35.1 ± 12.8 mm to 52.8 ± 4.6 and 21.4 ± 11.8 mm, respectively; P = 0.01 for both parameters). A sharp, transient increase of t-PA had no effect on maximum lysis in the NATEM test. PAI-1 increased significantly 3 h after the start of LPS infusion, paralleled by a decrease in maximum lysis. In conclusion, TEM was superior to standard coagulation tests in reflecting initial activation of coagulation during endotoxinemia. TEM further suggested consumption of coagulation substrate; at the same time, inhibition of plasminogen activation was accompanied by improved clot stability. Further investigations are necessar
Benny Sorensen - One of the best experts on this subject based on the ideXlab platform.
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comparison of whole blood fibrin based clot tests in thrombelastography and Thromboelastometry
Anesthesia & Analgesia, 2012Co-Authors: Cristina Solomon, Gerald Hochleitner, Benny Sorensen, Marco Ranucci, Jeffry Kashuk, Herbert SchochlAbstract:BACKGROUND: Fibrin-based clot firmness is measured as maximum amplitude (MA) in the functional fibrinogen (FF) thrombelastographic assay and maximum clot firmness (MCF) in the FIBTEM thromboelastometric assay. Differences between the assays/devices may be clinically significant. Our objective was to compare clot firmness parameters through standard (FF on a thrombelastography device [TEG®]; FIBTEM on a Thromboelastometry device [ROTEM®]) and crossover (FF on ROTEM®; FIBTEM on TEG®) analyses. METHODS: Whole-blood samples from healthy volunteers were subjected to thrombelastography and Thromboelastometry analyses. Samples were investigated native and following stepwise dilution with sodium chloride solution (20%, 40%, and 60% dilution). Samples were also assessed after in vitro addition of medications (heparin, protamine, tranexamic acid) and 50% dilution with hydroxyethyl starch, gelatin, sodium chloride, and albumin. RESULTS: FF produced higher values than FIBTEM, regardless of the device, and TEG® produced higher values than ROTEM®, regardless of the assay. With all added medications except heparin 400 U/kg bodyweight, FF MA remained significantly higher (P 50%. CONCLUSIONS: These results demonstrate differences when measuring fibrin-based clotting via the FF and FIBTEM assays on the TEG® and ROTEM® devices. Point-of-care targeted correction of fibrin-based clotting may be influenced by the assay and device used. For the FF assay, data are lacking.
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a comparison of fibrinogen measurement methods with fibrin clot elasticity assessed by Thromboelastometry before and after administration of fibrinogen concentrate in cardiac surgery patients
Transfusion, 2011Co-Authors: Cristina Solomon, Gerald Hochleitner, Herbert Schochl, Benny Sorensen, Janne Cadamuro, Bernhard Ziegler, Michael Varvenne, Niels RahemeyerAbstract:BACKGROUND: Fibrinogen concentrate administration can be guided by measuring fibrinogen concentration or quality of the fibrin-based clot. This study compared different fibrinogen concentration measurement methods with maximum clot firmness (MCF) of the fibrin clot, assessed by Thromboelastometry (FIBTEM), in 33 cardiovascular surgery patients receiving fibrinogen concentrate for hemostatic therapy. STUDY DESIGN AND METHODS: Blood samples were collected after cardiopulmonary bypass (CPB) and after fibrinogen concentrate administration. FIBTEM MCF was measured using a rotational Thromboelastometry device (ROTEM, Tem International). Fibrinogen concentration was measured using photo-optical (CA-7000, Siemens Healthcare Diagnostics), mechanical (KC-10 steel ball, Schnitger and Gross hook, Amelung GmbH), and electromechanical (STA-R, Diagnostica Stago) coagulometers. Assessments included agreement between fibrinogen concentration measurements and correlations between fibrinogen concentration and FIBTEM MCF. RESULTS: After CPB, correlations were significant (p < 0.001) between FIBTEM MCF and fibrinogen concentration determined by steel ball (r = 0.71), hook (r = 0.73), STA-R (r = 0.81), and CA-7000 (r = 0.82) coagulometers. After fibrinogen concentrate administration, agreement between fibrinogen measurement methods was severely impaired, and correlations with FIBTEM MCF were 0.39 (steel ball), 0.33 (hook), 0.59 (STA-R), and 0.33 (CA-7000). CONCLUSION: Agreement between fibrinogen concentration measurement methods decreased considerably after fibrinogen concentrate administration. All methods correlated acceptably with FIBTEM MCF at the end of CPB, but not after hemostatic therapy. Further investigation is needed to explain these findings.
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mechanisms of hydroxyethyl starch induced dilutional coagulopathy
Journal of Thrombosis and Haemostasis, 2009Co-Authors: Christian Fengereriksen, E Tonnesen, Benny Sorensen, Jorgen IngerslevAbstract:Summary. Background: The biochemical mechanisms causing dilutional coagulopathy following infusion of hydroxyethyl starch 130/0.4 (HES) are not known in detail. Objectives: To give a detailed biochemical description of the mechanism of coagulopathy following 30%in vivo dilution with HES, to present a systematic ex vivo test of various hemostatic agents, and to investigate the hypothesis that acquired fibrinogen deficiency constitutes the most important determinant of the coagulopathy. Methods: Dynamic whole blood clot formation assessed by Thromboelastometry, platelet count, thrombin generation, and the activities of von Willebrand factor, coagulation factor II, FVII, FVIII, FIX, FX and FXIII were measured in 20 bleeding patients enrolled in a prospective clinical study investigating in vivo substitution of blood loss with HES up to a target level of 30%. Thromboelastometry parameters were further evaluated after ex vivo spiking experiments with fibrinogen, prothrombin complex concentrate (PCC), FXIII, activated recombinant FVIIa (rFVIIa), fresh frozen plasma, and platelets. Results: Hemodilution reduced maximum clot firmness (MCF), whereas whole blood clotting time (CT) and maximum velocity remained unaffected. All coagulation factor activities were reduced. Fibrinogen, FII, FXIII and FX activities decreased significantly below the levels expected from dilution. The endogenous thrombin potential was unchanged. Ex vivo addition of fibrinogen normalized the reduced MCF and increased the maximum velocity, whereas PCC, rFVIIa and platelets shortened the CT but showed no effect on the reduced MCF. Conclusions: Acquired fibrinogen deficiency seems to be the leading determinant in dilutional coagulopathy, and ex vivo addition corrected the coagulopathy completely.
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fibrinogen substitution improves whole blood clot firmness after dilution with hydroxyethyl starch in bleeding patients undergoing radical cystectomy a randomized placebo controlled clinical trial
Journal of Thrombosis and Haemostasis, 2009Co-Authors: Christian Fengereriksen, E Tonnesen, Jorgen Ingerslev, T M Jensen, B S Kristensen, Klaus Moller Jensen, Benny SorensenAbstract:Summary. Background: Infusion of artificial colloids such as hydroxyethyl starch (HES) induces coagulopathy to a greater extent than simple dilution. Several studies have suggested that the coagulopathy could be corrected by substitution with a fibrinogen concentrate. Objectives: The aims of the present prospective, randomized, placebo-controlled trial were to investigate the hemostatic effect of a fibrinogen concentrate after coagulopathy induced by hydroxyethyl starch in patients experiencing sudden excessive bleeding during elective cystectomy. Methods: Twenty patients were included. Blood loss was substituted 1:1 with HES 130/0.4. At a dilution level of 30%, patients were randomly selected for intra-operative administration of a fibrinogen concentrate or placebo. The primary endpoint was maximum clot firmness (MCF), as assessed by Thromboelastometry. Secondary endpoints were blood loss and transfusion requirements, other Thromboelastometry parameters, thrombin generation and platelet function. Results: Wholeblood MCF was significantly reduced after 30% dilution in vivo with HES. The placebo resulted in af urther decline of the MCF, whereas randomized administration of fibrinogen significantly increased the MCF. Furthermore, only 2 out of 10 patients randomly chosen to receive fibrinogen substitution required postoperative red blood cell transfusions, compared with 8 out of 10 in the placebo group (P = 0.023). Platelet function and thrombin generation were reduced after 30% hemodilution in vivo, and fibrinogen administration caused no significant changes. Conclusions: During cystectomy, fluid resuscitation with HES 130/0.4 during sudden excessive bleeding induces coagulopathy that shows reduced whole-blood maximum clot firmness. Randomized administration of fibrinogen concentrate significantly improved maximum clot firmness and reduced the requirement for postoperative transfusion.
Klaus Gorlinger - One of the best experts on this subject based on the ideXlab platform.
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rotational Thromboelastometry rotem
2016Co-Authors: Klaus Gorlinger, Daniel Dirkmann, Alexander A HankeAbstract:Thromboelastometry (ROTEM®) is an advancement of the classical thromboelastography. Several technical enhancements made the device more robust and user-friendly, reduced intra- and inter-operator variability, and improved the diagnostic performance. This allows for using the device at the bedside in a mobile way and in a multiuser environment, even in military settings. The ROTEM® device is not only able to detect multiple aspects of trauma-induced coagulopathy (TIC) and disseminated intravascular coagulation (DIC), but it allows for prediction of bleeding, massive transfusion, thrombosis, and mortality, too. Furthermore, the ROTEM® device is designed to guide hemostatic therapy with allogeneic blood products (RBC, FFP, cryoprecipitate, and platelets) and in particular with specific coagulation factor concentrates (fibrinogen concentrate, prothrombin complex concentrate (PCC), factor XIII concentrate, and rFVIIa). Here, the combination of specific ROTEM® assays improved the diagnostic performance, significantly. Finally, the implementation of ROTEM®-guided bleeding management algorithms (“Theragnostic Approach”) has been shown to reduce transfusion requirements, complication rates, morbidity, mortality, and hospital costs in trauma and other clinical settings.
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effect of haematocrit on fibrin based clot firmness in the fibtem test
Vox Sanguinis, 2013Co-Authors: Cristina Solomon, Herbert Schochl, Niels Rahemeyer, Marco Ranucci, Klaus GorlingerAbstract:Background Point-of-care Thromboelastometry (ROTEM®) can be used to assess coagulation in whole blood. In the ROTEM® FIBTEM test, cytochalasin D eliminates the contribution of platelets to the whole blood clot; hence, only the remaining elements, including fibrinogen/fibrin, red blood cells and factor XIII, contribute to clot strength. We investigated the relationships between FIBTEM maximum clot firmness (MCF), whole blood fibrinogen concentration and plasma fibrinogen concentration to determine the impact of haematocrit on these parameters during cardiac surgery.
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first line therapy with coagulation factor concentrates combined with point of care coagulation testing is associated with decreased allogeneic blood transfusion in cardiovascular surgery a retrospective single center cohort study
Anesthesiology, 2011Co-Authors: Klaus Gorlinger, Alexander A Hanke, Daniel Dirkmann, Markus Kamler, Eva Kottenberg, Matthias Thielmann, Heinz Jakob, Jurgen PetersAbstract:Introduction: Blood transfusion is associated with increased morbidity and mortality. We developed and implementedanalgorithmforcoagulationmanagementincardiovascular surgery based on first-line administration of coagulationfactorconcentratescombinedwithpoint-of-care Thromboelastometry/impedance aggregometry. Methods: In a retrospective cohort study including 3,865 patients, we analyzed the incidence of intraoperative allogeneic blood transfusions (primary endpoints) before and after algorithm implementation. Results: Following algorithm implementation, the incidence of any allogeneic blood transfusion (52.5 vs. 42.2%; P 0.0001), packed red blood cells (49.7 vs. 40.4%; P 0.0001), and fresh frozen plasma (19.4 vs. 1.1%; P
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comparison of Thromboelastometry with procalcitonin interleukin 6 and c reactive protein as diagnostic tests for severe sepsis in critically ill adults
Critical Care, 2010Co-Authors: Michael Adamzik, Klaus Gorlinger, Fuat H Saner, Martin Eggmann, Ulrich H Frey, Martina Brockerpreus, G Marggraf, Holger Eggebrecht, Jurgen Peters, Matthias HartmannAbstract:Established biomarkers for the diagnosis of sepsis are procalcitonin, interleukin 6, and C-reactive protein. Although sepsis evokes changes of coagulation and fibrinolysis, it is unknown whether Thromboelastometry can detect these alterations. We investigated whether Thromboelastometry variables are suitable as biomarkers for severe sepsis in critically ill adults. In the observational cohort study, blood samples were obtained from patients on the day of diagnosis of severe sepsis (n = 56) and from postoperative patients (n = 52), and clotting time, clot formation time, maximum clot firmness, alpha angle, and lysis index were measured with Thromboelastometry. In addition, procalcitonin, interleukin 6, and C-reactive protein levels were determined. For comparison of biomarkers, receiver operating characteristic (ROC) curves were used, and the optimal cut-offs and odds ratios were calculated. In comparison with postoperative controls, patients with sepsis showed an increase in lysis index (97% ± 0.3 versus 92 ± 0.5; P 96.5%, resulting in a sensitivity of 84.2%, and a specificity of 94.2%, with an odds ratio of 85.3 (CI 21.7 - 334.5). The Thromboelastometry lysis index proved to be a more reliable biomarker of severe sepsis in critically ill adults than were procalcitonin, interleukin 6, and C-reactive protein. The results also demonstrate that early involvement of the hemostatic system is a common event in severe sepsis.
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Rotational thrombelastometry for the bedside monitoring of recombinant hirudin
Acta Anaesthesiologica Scandinavica, 2008Co-Authors: Christoph Sucker, Rainer B Zotz, Klaus Gorlinger, Matthias HartmannAbstract:Background: Recombinant hirudin is used as an alternative anticoagulant, particularly in patients with heparin-induced thrombocytopenia type II. However, bedside monitoring for hirudin is not available. The present study aims to evaluate rotational thrombelastometry regarding its suitability to detect the effects of recombinant hirudin on whole blood coagulation. Hirudin was added to whole blood samples from healthy donors (n = 5) and thrombelastometry variables resulting from activation of samples with tissue factor, ellagic acid, and ecarin were determined. Methods: Hirudin (0.1-10 μg/ml) was added to citrated blood. Thereafter, rotational thrombelastometry was performed by initiating coagulation via recalcification and addition of tissue factor, ellagic acid, and ecarin, respectively, using the commercially available assays. Results: In the absence of hirudin, clotting times (CT) induced by ellagic acid, tissue factor, and ecarin, respectively, were 141.7 ± 18.0, 54.0 ± 7.6, and 64.5 ± 4.1 s. Increasing concentrations of hirudin led to dose-dependent prolongation of the clotting time with the three activators. All assays were capable to detect hirudin concentrations in the range of 0.5-5 μg/ml. At a final hirudin concentration of 1 μg/ml, clotting time increased to 268.0 ± 25.1, 84.0 ± 9.3, and 107.5 ± 9.9s, respectively, with the above-mentioned activators. The other thrombelastographic variables, including clot formation time, angle α, and maximum clot firmness, were not altered by hirudin at concentrations up to 5 μg/ml. Conclusions: Our study demonstrates the suitability of rotational thrombelastometry to detect anticoagulant effects of recombinant hirudin.
Anders Jeppsson - One of the best experts on this subject based on the ideXlab platform.
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earlier detection of coagulopathy with Thromboelastometry during pediatric cardiac surgery a prospective observational study
Pediatric Anesthesia, 2013Co-Authors: Birgitta S Romlin, Hakan Wahlander, Mats Synnergren, Fariba Baghaei, Anders JeppssonAbstract:SummaryObjective Earlier detection of coagulopathy in pediatric cardiac surgery patients. Aim To determine whether Thromboelastometry (TEM) analysis before weaning from cardiopulmonary bypass (CPB) and hemoconcentration is predictive of post-CPB results and whether analysis of clot firmness already after 10 min yields reliable results. Background Cardiac surgery with CPB induces a coagulopathy that may contribute to postoperative complications. Earlier detection increases the possibility of initiating countermeasures. Methods/Material Fifty-six pediatric cardiac surgery patients were included in a prospective observational study. HEPTEM and FIBTEM clotting time (CT), clot formation time (CFT), and clot firmness after 10 min (A10) and at maximum (MCF) were analyzed during CPB and after CPB and ultrafiltration with modified rotational Thromboelastometry (ROTEM®). The analyses were compared, and correlations and differences were calculated. Results Hemoconcentration with modified ultrafiltration increased hematocrit from 28 ± 3 to 37 ± 4% (P < 0.001). Correlation coefficients of the TEM variables during and after CPB ranged from 0.61 to 0.82 (all P < 0.001). HEPTEM-CT and HEPTEM-MCF differed significantly but the differences were marginal. Both HEPTEM and FIBTEM A10 measurements during CPB were significantly less than MCF (P < 0.001 for both), but the correlations were highly significant (HEPTEM: r = 0.95, P < 0.001; FIBTEM: r = 0.96, P < 0.001), and the differences were predictable, with narrow confidence intervals (HEPTEM: −8.2 mm (−8.9 to −7.5); FIBTEM: −0.5 mm (−0.7 to −0.3). Conclusion The results suggest that intraoperative TEM analyses can be accelerated by analyzing HEPTEM/FIBTEM on CPB before hemoconcentration and by analyzing clot firmness already after 10 min.
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intraoperative Thromboelastometry is associated with reduced transfusion prevalence in pediatric cardiac surgery
Anesthesia & Analgesia, 2011Co-Authors: Birgitta S Romlin, Hakan Wahlander, Hakan Berggren, Mats Synnergren, Fariba Baghaei, Krister Nilsson, Anders JeppssonAbstract:BACKGROUND: The majority of pediatric cardiac surgery patients receive blood transfusions. We hypothesized that the routine use of intraoperative Thromboelastometry to guide transfusion decisions would reduce the overall proportion of patients receiving transfusions in pediatric cardiac surgery. METHODS: One hundred pediatric cardiac surgery patients were included in the study. Fifty patients (study group) were prospectively included and compared with 50 procedure- and age-matched control patients (control group). In the study group, Thromboelastometry, performed during cardiopulmonary bypass, guided intraoperative transfusions. Intraoperative and postoperative transfusions of packed red blood cells, fresh frozen plasma, platelets, and fibrinogen concentrates, and postoperative blood loss and hemoglobin levels were compared between the 2 groups. RESULTS: The proportion of patients receiving any intraoperative or postoperative transfusion of packed red blood cells, fresh frozen plasma, platelets, or fibrinogen concentrates was significantly lower in the study group than in the control group (32 of 50 [64%] vs 46 of 50 [92%], respectively; P < 0.001). Significantly fewer patients in the study group received transfusions of packed red blood cells (58% vs 78%, P = 0.032) and plasma (14% vs 78%, P < 0.001), whereas more patients in the study group received transfusions of platelets (38% vs 12%, P = 0.002) and fibrinogen concentrates (16% vs 2%, P = 0.015). Neither postoperative blood loss nor postoperative hemoglobin levels differed significantly between the study group and the control group. CONCLUSIONS: The results suggest that routine use of intraoperative Thromboelastometry in pediatric cardiac surgery to guide transfusions is associated with a reduced proportion of patients receiving transfusions and an altered transfusion pattern.
