Thromboelastography and rotational thromboelastometry in bleeding patients with coagulopathy: Practice management guideline from the Eastern Association for the Surgery of Trauma
| Autor: | Brian K. Yorkgitis, Guy Golani, Nikolay Bugaev, George Kasotakis, Nicole M. Garcia, Hiba Abdel Aziz, Jennifer J. Freeman, Peter A. Pappas, John J. Como, Eric J. Mahoney, Jaswin S Sawhney, Zachary W Brown, Cory Vatsaas, Laura A Kreiner |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry 030208 emergency & critical care medicine Evidence-based medicine Guideline Critical Care and Intensive Care Medicine medicine.disease Thromboelastography 03 medical and health sciences Thromboelastometry 0302 clinical medicine Blood product medicine Coagulopathy Coagulation testing Surgery Intensive care medicine business Blood coagulation test |
| Zdroj: | Journal of Trauma and Acute Care Surgery. 89:999-1017 |
| ISSN: | 2163-0763 2163-0755 |
| DOI: | 10.1097/ta.0000000000002944 |
| Popis: | 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, which are 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 with non-TEG/ROTEM-guided blood products transfusions strategies were performed. The Grading of Recommendations Assessment, Development and Evaluation 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 Using 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. Thromboelastography/ROTEM-guided transfusions were associated with a reduced number of additional invasive hemostatic interventions (angioembolic, endoscopic, or surgical) in surgical patients. Thromboelastography/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 adult patients with critical illness. Level of evidence Systematic Review/Meta-Analysis, level III. |
| Databáze: | OpenAIRE |
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