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The impact of RoTEM generation coagulation data on transfusion practices in trauma Al-Masrouri, Safiya Mohammed Hamed


BACKGROUND: Coagulopathy in trauma is believed to result from complex hemostatic disturbances known as Acute Traumatic Coagulopathy. The current diagnostic modalities fail to characterize these disturbances in clinically relevant time frames. Recently, there has been an increasing interest in utilizing of Viscoelastic Hemostatic Assays (RoTEM, Rotational Thromboelastometry; TEG, Thromboelastometry) in the diagnosis of ATC and guiding initial phases of resuscitation. We aim in this study to assess the role of RoTEM assay in the diagnosis and management of ATC. METHODS AND RESULTS: We conducted a systematic review to investigate the role of RoTEM assays in the diagnosis and the management of ATC. A total of 20 studies were included and they have shown that not only RoTEM parameters had a good detection rate of ATC, but also they provided more data on clot firmness, stability and lysis in a shorter span of time. Moreover, they were independent predictors of mortality, morbidity and massive transfusion. Utilizing these parameters to guide blood transfusion has the potential to decrease the exposure of allogeneic blood products. In addition, we designed a before-and-after study to assess the role of RoTEM assays in early diagnosis of ATC and on utilization of blood products among all trauma team activations in a level-1 trauma center setting. Interim analysis (October 2014 – March 2015) have revealed that out of 63 trauma patients, only one (1.6%) had INR < 1.2 and two (3.2%) had fibrinogen < 1.4 g/L. RoTEM parameters had a significant correlation with CCT parameters and appeared to be more sensitive than CCT in detecting coagulation disturbances in stable but severely injured patients. The impact on transfusion practices was not assessed as the study recruited small number of patients. CONCLUSION: RoTEM assays are potentially useful diagnostic tools in the field of trauma resuscitation. They provide a rapid a reliable means to assess coagulation disturbances. Obtaining these assays in clinically relevant time frames allows for targeted hemostatic therapy and that can potentially reduce the exposure to allogeneic blood products. The impact of these assays on transfusion practices and patients’ outcomes is yet to be validated through multi-center randomized clinical trials.

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