Thromboelastography (TEG) or rotational thromboelastometry (ROTEM) to monitor haemostatic treatment in bleeding patients: a systematic review with meta-analysis and trial sequential analysis.
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TLDR
Transfusion strategies guided by thromboelastography or rotational thrombaelastometry may reduce the need for blood products in patients with bleeding, but the results are mainly based on trials of elective cardiac surgery involving cardiopulmonary bypass, with low‐quality evidence.Abstract:
Coagulopathy and severe bleeding are associated with high mortality. We evaluated haemostatic treatment guided by the functional viscoelastic haemostatic assays, thromboelastography or rotational thromboelastometry in bleeding patients. We searched for randomised, controlled trials irrespective of publication status, publication date, blinding status, outcomes published or language from date of inception to 5 January 2016 in six bibliographic databases. We included 17 trials (1493 participants), most involving cardiac surgery. Thromboelastography or rotational thromboelastometry seemed to reduce overall mortality compared to any of our comparisons (3.9% vs. 7.4%, RR (95% CI) 0.52 (0.28-0.95); I2 = 0%, 8 trials, 717 participants). However, the quality of evidence is graded as low due to the high risk of bias, heterogeneity, imprecision and low event rate. Thromboelastography or rotational thromboelastometry significantly reduced the proportion of patients transfused with red blood cells (RR (95% CI) 0.86 (0.79-0.94); I2 = 0%, 10 trials, 832 participants), fresh frozen plasma (RR (95% CI) 0.57 (0.33-0.96); I2 = 86%, 10 trials, 832 participants) and platelets (RR (95% CI) 0.73 (0.60-0.88); I2 = 0%, 10 studies, 832 participants). There was no difference in proportion needing surgical re-interventions (RR (95% CI) 0.75 (0.50-1.10); I2 = 0%, 9 trials, 887 participants). Trial sequential analysis of mortality suggests that only 54% of the required information size has been reached so far. Transfusion strategies guided by thromboelastography or rotational thromboelastometry may reduce the need for blood products in patients with bleeding, but the results are mainly based on trials of elective cardiac surgery involving cardiopulmonary bypass, with low-quality evidence.read more
Citations
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Journal ArticleDOI
Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding.
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References
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Thromboelastometrically guided transfusion protocol during aortic surgery with circulatory arrest: a prospective, randomized trial.
Evaldas Girdauskas,Jörg Kempfert,Thomas Kuntze,Michael A. Borger,Jörg Enders,Jens Fassl,Volkmar Falk,Friedrich-Wilhelm Mohr +7 more
TL;DR: Thromboelastometrically guided transfusion is associated with a decreased use of allogeneic blood units and reduced incidence of massive transfusion in patients undergoing aortic surgery with circulatory arrest.
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How I treat patients with massive hemorrhage
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TL;DR: This work presents how hospitals in Copenhagen and Houston, today, manage patients with massive hemorrhage and introduces a strategy aiming at avoiding coagulopathy by proactive resuscitation with blood products in a balanced ratio of RBC:plasma:platelets.
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High-sensitivity troponin assays for the early rule-out or diagnosis of acute myocardial infarction in people with acute chest pain: a systematic review and cost-effectiveness analysis
Marie Westwood,Thea van Asselt,Bram Ramaekers,Penny Whiting,Praveen Thokala,Manuela A. Joore,Nigel Armstrong,Janine Ross,Johan L. Severens,Jos Kleijnen +9 more
TL;DR: There is some evidence to suggest that high-sensitivity cardiac troponin (hs-cTn) testing may provide an effective and cost-effective approach to early rule-out of AMI.
Journal ArticleDOI
Thromboelastometry-guided intraoperative haemostatic management reduces bleeding and red cell transfusion after paediatric cardiac surgery
Yoshinobu Nakayama,Yasufumi Nakajima,Kenichi A. Tanaka,Daniel I. Sessler,S. Maeda,J. Iida,Satoru Ogawa,Toshiki Mizobe +7 more
TL;DR: Rotational thromboelastometry-guided early haemostatic intervention by rapid intraoperative correction of EXTEM-A10 and FIBTEM- a10 reduced blood loss and red cell transfusion requirements after CPB, and reduced critical care duration in paediatric cardiac surgical patients.
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Blood transfusion and the anaesthetist: management of massive haemorrhage
D Thomas,M. Y. K. Wee,P Clyburn,I Walker,Karim Brohi,P Collins,H Doughty,J Isaac,PF Mahoney,L Shewry +9 more
TL;DR: “Hospitals must have a major haemorrhage protocol in place and this should include clinical, laboratory and logistic responses,” says the World Health Organization.
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