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Viscoelastic Hemostatic Tests and Fibrinogen Concentrations in Trauma

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Biomarkers in Trauma, Injury and Critical Care

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Abstract

Thrombelastography (TEG) and rotational thromboelastometry (ROTEM) are used to diagnose trauma-induced coagulopathy, fibrinogen deficiency, and guide fibrinogen transfusion in trauma, as well as to study the hemostatic effect of fibrinogen supplementation. We reviewed the clinical applications of TEG and ROTEM focusing on two functional fibrinogen (FF) tests, TEG FF and ROTEM FIBTEM, for assessing and guiding fibrinogen replacement in trauma patients. ROTEM FIBTEM, the standard FF test, measures clot amplitude. In contrast, while TEG FF, which is considered the standard FF test, also measures clot amplitude, other TEG tests, e.g., kaolin and rapid TEG, measure several coagulation parameters (maximum amplitude, K value, and angle α) to assess FF. Some confounding factors (e.g., hematocrit, factor XIII, and resuscitation fluids) need to be considered when interpreting the hemostatic effect of fibrinogen replacement measured by TEG and ROTEM. Different cutoff values for TEG and ROTEM parameters, particularly for maximum clot firmness (MCF) in FIBTEM, have been used for fibrinogen replacement. The dosage of fibrinogen replacement can be calculated based on the desired increment in the FIBTEM MCF or plasma fibrinogen level. In addition, we compared the clinical performance of the two FF test systems; the results were correlated but not interchangeable.

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Abbreviations

ACT:

Activated clotting time

CAs:

Clot amplitudes

CCTs:

Conventional coagulation tests

CFT:

Clot formation time

CL30:

Clot amplitude at 30 min after MA relative to MA

CT:

Coagulation time

ELISA:

Enzyme-linked immunosorbent assay

FC:

Fibrinogen concentrate

FF:

Functional fibrinogen

FFP:

Fresh frozen plasma

INR:

International normalized ratio

K:

Kinetic time

LI30:

Lysis index at 30 min after CT

LY30:

Clot lysis at 30 min after MA

MA:

Maximum amplitude

MCF:

Maximum clot firmness

PT:

Prothrombin time

PTT:

Partial thromboplastin time

R:

Reaction time

RBC:

Red blood cells

ROTEM:

Rotational thromboelastometry

SLT:

Standard laboratory test

TEG:

Thrombelastography

TIC:

Trauma-inducted coagulopathy

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  1. Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada

    Henry T. Peng

  2. St. Michael’s Hospital, Toronto, ON, Canada

    Andrew Beckett

  3. Royal Canadian Medical Services, Ottawa, ON, Canada

    Andrew Beckett

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    Rajkumar Rajendram

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    Victor R. Preedy

  3. Department of Biomedical Sciences, University of Westminster, London, UK

    Vinood B. Patel

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Peng, H.T., Beckett, A. (2022). Viscoelastic Hemostatic Tests and Fibrinogen Concentrations in Trauma. In: Rajendram, R., Preedy, V.R., Patel, V.B. (eds) Biomarkers in Trauma, Injury and Critical Care. Biomarkers in Disease: Methods, Discoveries and Applications. Springer, Cham. https://doi.org/10.1007/978-3-030-87302-8_14-1

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