Defence Research and Development Canada, Toronto Research Center, Toronto, ON, Canada.
Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Clin Chim Acta. 2019 Aug;495:253-262. doi: 10.1016/j.cca.2019.04.066. Epub 2019 Apr 17.
Both thrombelastography (TEG) and rotational thromboelastometry (ROTEM) have been investigated for diagnosis of coagulopathy and guidance of resuscitation in trauma and surgery. Given similarities between the two systems, it is important to determine whether one is superior to the other and how comparable they are to conventional coagulation tests (CCTs). Therefore, we conducted a comparative study of functional fibrinogen and coagulation assays using TEG and ROTEM and CCTs to determine their capability to monitor coagulation profiles, diagnose coagulopathy and predict blood transfusion requirements in trauma patients.
Blood samples were collected from 45 patients at admission and during 48-h hospitalization as part of a randomized control trial on early fibrinogen replacement in trauma. Functional fibrinogen (FF) TEG, ROTEM FIBTEM and EXTEM, and CCTs were performed and compared.
We found significant differences between the placebo and fibrinogen groups over hospitalization time in FF TEG MA, ROTEM CT, MCF and LI30. FF TEG MA and ROTEM FIBTEM MCF mirrored plasma fibrinogen profiles, reached a maximum difference between the two groups 1-3 h after fibrinogen administration. In comparison, CCTs detected minimal hemostatic changes by fibrinogen treatment. TEG and ROTEM showed various degrees of correlations with CCTs. TEG MA and ROTEM MCF provided better predictions for plasma and RBC transfusions than CCTs, but poor accuracy for cryoprecipitate transfusion. Both TEG and ROTEM well predicted hypofibrinogenemia (fibrinogen concentration < 1 g/L), but poorly detected coagulopathy (INR ≥ 1.2).
TEG and ROTEM detected increases in clot strength following early use of fibrinogen. ROTEM also detected changes in coagulation time and clot lysis. Both were better than CCTs for monitoring coagulation profiles and predicting transfusion requirements.
血栓弹力描记术（TEG）和旋转血栓弹性描记术（ROTEM）均已被用于创伤和手术中凝血功能障碍的诊断和复苏指导。鉴于两种系统之间存在相似性，重要的是要确定其中一种是否优于另一种，以及它们与常规凝血检测（CCT）的可比性如何。因此，我们进行了一项使用 TEG 和 ROTEM 以及 CCT 对功能性纤维蛋白原和凝血检测的比较研究，以确定它们监测凝血谱、诊断凝血功能障碍和预测创伤患者输血需求的能力。
作为创伤早期纤维蛋白原替代的随机对照试验的一部分，在入院时和住院期间的 48 小时内采集了 45 例患者的血液样本。进行了功能性纤维蛋白原（FF）TEG、ROTEM FIBTEM 和 EXTEM 以及 CCT 检测，并进行了比较。
我们发现，在住院期间，安慰剂组和纤维蛋白原组在 FF TEG MA、ROTEM CT、MCF 和 LI30 方面存在显著差异。FF TEG MA 和 ROTEM FIBTEM MCF 反映了血浆纤维蛋白原谱，在纤维蛋白原给药后 1-3 小时达到两组之间的最大差异。相比之下，CCT 在纤维蛋白原治疗后检测到最小的止血变化。TEG 和 ROTEM 与 CCT 显示出不同程度的相关性。TEG MA 和 ROTEM MCF 对血浆和 RBC 输血的预测优于 CCT，但对冷沉淀输血的准确性较差。TEG 和 ROTEM 均能很好地预测低纤维蛋白血症（纤维蛋白原浓度<1g/L），但不能很好地检测出凝血功能障碍（INR≥1.2）。
TEG 和 ROTEM 检测到早期使用纤维蛋白原后血栓强度增加。ROTEM 还检测到凝血时间和血凝块溶解的变化。与 CCT 相比，这两种方法在监测凝血谱和预测输血需求方面都更好。
