Viscoelastic hemostatic fibrinogen assays detect fibrinolysis early

  • J. N. HarrEmail author
  • E. E. MooreEmail author
  • T. L. Chin
  • M. P. Chapman
  • A. Ghasabyan
  • J. R. Stringham
  • A. Banerjee
  • C. C. Silliman
Original Article



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.


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.


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.


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.


Thrombelastography Thromboelastometry Fibrinogen Trauma-induced coagulopathy Fibrinolysis 



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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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • J. N. Harr
    • 1
    Email author
  • E. E. Moore
    • 1
    • 2
    • 3
    Email author
  • T. L. Chin
    • 1
  • M. P. Chapman
    • 4
  • A. Ghasabyan
    • 2
    • 3
  • J. R. Stringham
    • 1
  • A. Banerjee
    • 3
  • C. C. Silliman
    • 3
    • 5
    • 6
  1. 1.Department of SurgeryUniversity of Colorado DenverAuroraUSA
  2. 2.Department of SurgeryDenver Health Medical CenterDenverUSA
  3. 3.Trauma Research CenterUniversity of Colorado DenverAuroraUSA
  4. 4.Department of SurgeryMedical College of GeorgiaAugustaUSA
  5. 5.Department of PediatricsUniversity of Colorado DenverAuroraUSA
  6. 6.Research DepartmentBonfils Blood CenterDenverUSA

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