Drotarova Miroslava, Zolkova Jana, Belakova Kristina Maria, Brunclikova Monika, Skornova Ingrid, Stasko Jan, Simurda Tomas
National Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin, University Hospital in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia.
Diagnostics (Basel). 2023 Oct 16;13(20):3219. doi: 10.3390/diagnostics13203219.
Rotational thromboelastometry (ROTEM) is a viscoelastic method, which provides a graphical and numerical representation of induced hemostasis in whole blood samples. Its ability to quickly assess the state of hemostasis is used in the management of bleeding from a variety of causes. The separate activation of particular parts of hemocoagulation in INTEM, EXTEM, and FIBTEM tests allows for a more comprehensive and faster evaluation of the missing component of hemostasis followed by targeted therapy. One of the most common cause of coagulopathy is trauma-induced coagulopathy. Fibrinogen replacement therapy by ROTEM allows for the use of a standard dosage of fibrinogen, which has been shown to be successful in preventing dilutional coagulopathy following colloid and crystalloid replacement and excessive amount of allogeneic blood transfusions. The best reflection of fibrinogen activity is observed in the FIBTEM assay, where fibrinogen replacement therapy is recommended at an MCF (maximum clot firmness) of FIBTEM < 10 mm and FIBTEM A10 < 7 mm. ROTEM also plays an important role in the diagnostic and management of inherited fibrinogen disorders. These can be manifested by bleeding complications, where changes in the MCF parameter are the most useful tool for assessing the effectiveness of fibrinogen replacement therapy. ROTEM-guided bleeding management algorithms effectively reduce the number of transfusions, healthcare costs, and complications, leading to the improvement of patient safety and overall health.
旋转血栓弹力图（ROTEM）是一种粘弹性方法，可对全血样本中的诱导止血过程进行图形化和数值化呈现。其快速评估止血状态的能力被用于各种原因导致的出血管理。INTEM、EXTEM和FIBTEM检测中对凝血特定部分的单独激活，能够更全面、快速地评估止血缺失成分，进而进行靶向治疗。凝血病最常见的原因之一是创伤性凝血病。通过ROTEM进行纤维蛋白原替代治疗可使用标准剂量的纤维蛋白原，已证明其在预防胶体和晶体替代及大量异体输血后发生的稀释性凝血病方面是成功的。在FIBTEM检测中可观察到纤维蛋白原活性的最佳反映，当FIBTEM的最大血凝块硬度（MCF）<10mm且FIBTEM A10<7mm时，建议进行纤维蛋白原替代治疗。ROTEM在遗传性纤维蛋白原疾病的诊断和管理中也发挥着重要作用。这些疾病可能表现为出血并发症，其中MCF参数的变化是评估纤维蛋白原替代治疗效果最有用的工具。ROTEM指导的出血管理算法可有效减少输血次数、医疗成本和并发症，从而提高患者安全性和整体健康水平。
