Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 7 , ISSUE 2 ( May-August, 2018 ) > List of Articles

PRIMARY RESEARCH ARTICLE

A Comparative Analysis of Functional Fibrinogen Assays using TEG and ROTEM in Trauma Patients Enrolled in the FiiRST Trial

Homer Tien, Henry T Peng, Barto Nascimento, Jeannie Callum, Shawn G Rhind, Andrew Beckett

Keywords : Coagulation tests, Fibrinogen concentrate, Functional fibrinogen, Thrombelastography, Thromboelastometry, Trauma

Citation Information : Tien H, Peng HT, Nascimento B, Callum J, Rhind SG, Beckett A. A Comparative Analysis of Functional Fibrinogen Assays using TEG and ROTEM in Trauma Patients Enrolled in the FiiRST Trial. Panam J Trauma Crit Care Emerg Surg 2018; 7 (2):143-157.

DOI: 10.5005/jp-journals-10030-1217

License: CC BY-NC 4.0

Published Online: 01-08-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Given the growing use of both thrombelastography (TEG) and rotational thromboelastometry (ROTEM) in trauma and surgery, it is important to determine whether the two are interchangeable, and how comparable they are to Clauss fibrinogen assay and for clinical use. We recently completed a randomized control trial on early fibrinogen in trauma (the Fii RST trial). The object of this analysis was to evaluate the interchangeability and correlations between TEG and ROTEM functional fibrinogen assays in injured trauma patients. Also, we evaluated their correlation with Clauss fibrinogen and compared their potentials for diagnosis of coagulopathy and use in guided fibrinogen administration. Materials and Methods: The Post-hoc analysis of the coagulation data collected as part of the FiiRST trial. It was a comparative analysis of functional fibrinogen assays using TEG and ROTEM in trauma patients screened for hypotension and need for blood transfusion. TEG and ROTEM tests were also compared with Clauss fibrinogen assay and INR as additional analyses of their clinical use. Results: TEG and ROTEM parameter values were correlated but were significantly different, and their agreement fell outside acceptable limits and thus were not interchangeable. TEG maximum amplitude (MA) and ROTEM maximum clot firmness (MCF) showed closest correlations with Clauss fibrinogen concentration, particularly with ROTEM FIBTEM MCF (r = 0.84; p < 0.001). There were discrepancies between TEG and ROTEM in their detection of coagulation abnormalities, hypofibrinogenemia, and hyperfibrinolysis. Conclusion: TEG and ROTEM fibrinogen assay parameters were associated, especially between TEG MA and ROTEM MCF, showing the strongest correlation, but the parameters were not interchangeable. TEG and ROTEM showed varying extents of correlations with Clauss fibrinogen. Overall, ROTEM parameters exhibited better correlations with Clauss fibrinogen than TEG. Different algorithms for TEG and ROTEM need to be developed for diagnosis of coagulopathy and guided fibrinogen administration in trauma.


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