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Viscoelastic hemostatic fibrinogen assays detect fibrinolysis early

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

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.

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Acknowledgments

This study was supported by the National Institutes of Health (P50 GM049222 and T32 GM008315 grants). Devices, reagents, and supplies were provided through Haemonetics and Tem Innovations GmbH.

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.

Ethical standard statement

This study was approved under a protocol by the Colorado Multiple Institutional Review Board, and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All healthy volunteers gave their informed consent prior to their inclusion in the study.

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Authors and Affiliations

  1. Department of Surgery, University of Colorado Denver, Aurora, CO, USA

    J. N. Harr, E. E. Moore, T. L. Chin & J. R. Stringham

  2. Department of Surgery, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA

    E. E. Moore & A. Ghasabyan

  3. Trauma Research Center, University of Colorado Denver, Aurora, CO, USA

    E. E. Moore, A. Ghasabyan, A. Banerjee & C. C. Silliman

  4. Department of Surgery, Medical College of Georgia, Augusta, GA, USA

    M. P. Chapman

  5. Department of Pediatrics, University of Colorado Denver, Aurora, CO, USA

    C. C. Silliman

  6. Research Department, Bonfils Blood Center, Denver, CO, USA

    C. C. Silliman

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  1. J. N. Harr
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  2. E. E. Moore
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  3. T. L. Chin
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  4. M. P. Chapman
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  5. A. Ghasabyan
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  6. J. R. Stringham
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  7. A. Banerjee
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  8. C. C. Silliman
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Corresponding authors

Correspondence to J. N. Harr or E. E. Moore.

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Harr, J.N., Moore, E.E., Chin, T.L. et al. Viscoelastic hemostatic fibrinogen assays detect fibrinolysis early. Eur J Trauma Emerg Surg 41, 49–56 (2015). https://doi.org/10.1007/s00068-014-0400-0

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  • DOI: https://doi.org/10.1007/s00068-014-0400-0

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