Thromboelastography and Rotational Thromboelastometry in Bleeding Patients with Coagulopathy: Practice Management Guideline from the Eastern Association for the Surgery of Trauma.
Title
Thromboelastography and Rotational Thromboelastometry in Bleeding Patients with Coagulopathy: Practice Management Guideline from the Eastern Association for the Surgery of Trauma.
Creator
Bugaev N; Como JJ; Golani G; Freeman JJ; Sawhney JS; Vatsaas CJ; Yorkgitis BK; Kreiner LA; Garcia NM; Aziz Hiba A; Pappas PA; Mahoney EJ; Brown ZW; Kasotakis G
Publisher
The Journal of Trauma and Acute Care Surgery
Date
2020
2020-09-16
Description
BACKGROUND: Assessment of the immediate need for specific blood product transfusions in acutely bleeding patients is challenging. Clinical assessment and commonly used coagulation tests are inaccurate and time-consuming. The goal of this practice management guideline was to evaluate the role of the viscoelasticity tests: thromboelastography (TEG) and rotational thromboelastometry (ROTEM), in the management of acutely bleeding trauma, surgical and critically ill patients. METHODS: Systematic review and meta-analyses of manuscripts comparing TEG/ROTEM to non-TEG/ROTEM-guided blood products transfusions strategies were performed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied to assess the level of evidence and create recommendations for TEG/ROTEM-guided blood product transfusions in adult trauma, surgical, and critically ill patients. RESULTS: Utilizing TEG/ROTEM-guided blood transfusions in acutely bleeding trauma, surgical, and critically ill patients was associated with a tendency to fewer blood product transfusions in all populations. TEG/ROTEM-guided transfusions were associated with a reduced number of additional invasive hemostatic interventions (angioembolic, endoscopic, or surgical) in surgical patients. TEG/ROTEM -guided transfusions were associated with a reduction in mortality in trauma patients. CONCLUSION: In patients with ongoing hemorrhage and concern for coagulopathy, we conditionally recommend using TEG/ROTEM-guided transfusions, compared with traditional coagulation parameters, to guide blood component transfusions in each of the following three groups: adult trauma patients, adult surgical patients, and patients with critical illness. LEVEL OF EVIDENCE: Level II TYPE OF STUDY: Therapeutic.
Identifier
Rights
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Format
journalArticle
URL Address
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ISSN
2163-0763 2163-0755
Update Year & Number
Hospital List
Citation
Bugaev N; Como JJ; Golani G; Freeman JJ; Sawhney JS; Vatsaas CJ; Yorkgitis BK; Kreiner LA; Garcia NM; Aziz Hiba A; Pappas PA; Mahoney EJ; Brown ZW; Kasotakis G, “Thromboelastography and Rotational Thromboelastometry in Bleeding Patients with Coagulopathy: Practice Management Guideline from the Eastern Association for the Surgery of Trauma.,” NEOMED Bibliography Database, accessed April 24, 2024, https://neomed.omeka.net/items/show/11438.