Comparison of whole blood fibrin-based clot tests in thrombelastography and thromboelastometry

Cristina Solomon, Benny Sørensen, Gerald Hochleitner, Jeffry Kashuk, Marco Ranucci, Herbert Schöchl

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Fibrin-based clot firmness is measured as maximum amplitude (MA) in the functional fibrinogen (FF) thrombelastographic assay and maximum clot firmness (MCF) in the FIBTEM thromboelastometric assay. Differences between the assays/devices may be clinically significant. Our objective was to compare clot firmness parameters through standard (FF on a thrombelastography device [TEG®]; FIBTEM on a thromboelastometry device [ROTEM®]) and crossover (FF on ROTEM®; FIBTEM on TEG®) analyses. METHODS: Whole-blood samples from healthy volunteers were subjected to thrombelastography and thromboelastometry analyses. Samples were investigated native and following stepwise dilution with sodium chloride solution (20%, 40%, and 60% dilution). Samples were also assessed after in vitro addition of medications (heparin, protamine, tranexamic acid) and 50% dilution with hydroxyethyl starch, gelatin, sodium chloride, and albumin. RESULTS: FF produced higher values than FIBTEM, regardless of the device, and TEG® produced higher values than ROTEM®, regardless of the assay. With all added medications except heparin 400 U/kg bodyweight, FF MA remained significantly higher (P <0.05) than FIBTEM MCF, which was largely unchanged. FF MA was significantly reduced (P = 0.04) by high-dose heparin and partially restored with protamine. Fifty percent dilution with hydroxyethyl starch, albumin, and gelatin decreased FIBTEM MCF and FF MA by >50%. CONCLUSIONS: These results demonstrate differences when measuring fibrin-based clotting via the FF and FIBTEM assays on the TEG® and ROTEM® devices. Point-of-care targeted correction of fibrin-based clotting may be influenced by the assay and device used. For the FF assay, data are lacking.

Original languageEnglish
Pages (from-to)721-730
Number of pages10
JournalAnesthesia and Analgesia
Volume114
Issue number4
DOIs
Publication statusPublished - Apr 2012

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Thrombelastography
Fibrin
Fibrinogen
Equipment and Supplies
Sodium Chloride
Heparin
Point-of-Care Systems
Tranexamic Acid
Protamines
Gelatin
Starch
Albumins
Healthy Volunteers

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Comparison of whole blood fibrin-based clot tests in thrombelastography and thromboelastometry. / Solomon, Cristina; Sørensen, Benny; Hochleitner, Gerald; Kashuk, Jeffry; Ranucci, Marco; Schöchl, Herbert.

In: Anesthesia and Analgesia, Vol. 114, No. 4, 04.2012, p. 721-730.

Research output: Contribution to journalArticle

Solomon, Cristina ; Sørensen, Benny ; Hochleitner, Gerald ; Kashuk, Jeffry ; Ranucci, Marco ; Schöchl, Herbert. / Comparison of whole blood fibrin-based clot tests in thrombelastography and thromboelastometry. In: Anesthesia and Analgesia. 2012 ; Vol. 114, No. 4. pp. 721-730.
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T1 - Comparison of whole blood fibrin-based clot tests in thrombelastography and thromboelastometry

AU - Solomon, Cristina

AU - Sørensen, Benny

AU - Hochleitner, Gerald

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AU - Schöchl, Herbert

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N2 - BACKGROUND: Fibrin-based clot firmness is measured as maximum amplitude (MA) in the functional fibrinogen (FF) thrombelastographic assay and maximum clot firmness (MCF) in the FIBTEM thromboelastometric assay. Differences between the assays/devices may be clinically significant. Our objective was to compare clot firmness parameters through standard (FF on a thrombelastography device [TEG®]; FIBTEM on a thromboelastometry device [ROTEM®]) and crossover (FF on ROTEM®; FIBTEM on TEG®) analyses. METHODS: Whole-blood samples from healthy volunteers were subjected to thrombelastography and thromboelastometry analyses. Samples were investigated native and following stepwise dilution with sodium chloride solution (20%, 40%, and 60% dilution). Samples were also assessed after in vitro addition of medications (heparin, protamine, tranexamic acid) and 50% dilution with hydroxyethyl starch, gelatin, sodium chloride, and albumin. RESULTS: FF produced higher values than FIBTEM, regardless of the device, and TEG® produced higher values than ROTEM®, regardless of the assay. With all added medications except heparin 400 U/kg bodyweight, FF MA remained significantly higher (P <0.05) than FIBTEM MCF, which was largely unchanged. FF MA was significantly reduced (P = 0.04) by high-dose heparin and partially restored with protamine. Fifty percent dilution with hydroxyethyl starch, albumin, and gelatin decreased FIBTEM MCF and FF MA by >50%. CONCLUSIONS: These results demonstrate differences when measuring fibrin-based clotting via the FF and FIBTEM assays on the TEG® and ROTEM® devices. Point-of-care targeted correction of fibrin-based clotting may be influenced by the assay and device used. For the FF assay, data are lacking.

AB - BACKGROUND: Fibrin-based clot firmness is measured as maximum amplitude (MA) in the functional fibrinogen (FF) thrombelastographic assay and maximum clot firmness (MCF) in the FIBTEM thromboelastometric assay. Differences between the assays/devices may be clinically significant. Our objective was to compare clot firmness parameters through standard (FF on a thrombelastography device [TEG®]; FIBTEM on a thromboelastometry device [ROTEM®]) and crossover (FF on ROTEM®; FIBTEM on TEG®) analyses. METHODS: Whole-blood samples from healthy volunteers were subjected to thrombelastography and thromboelastometry analyses. Samples were investigated native and following stepwise dilution with sodium chloride solution (20%, 40%, and 60% dilution). Samples were also assessed after in vitro addition of medications (heparin, protamine, tranexamic acid) and 50% dilution with hydroxyethyl starch, gelatin, sodium chloride, and albumin. RESULTS: FF produced higher values than FIBTEM, regardless of the device, and TEG® produced higher values than ROTEM®, regardless of the assay. With all added medications except heparin 400 U/kg bodyweight, FF MA remained significantly higher (P <0.05) than FIBTEM MCF, which was largely unchanged. FF MA was significantly reduced (P = 0.04) by high-dose heparin and partially restored with protamine. Fifty percent dilution with hydroxyethyl starch, albumin, and gelatin decreased FIBTEM MCF and FF MA by >50%. CONCLUSIONS: These results demonstrate differences when measuring fibrin-based clotting via the FF and FIBTEM assays on the TEG® and ROTEM® devices. Point-of-care targeted correction of fibrin-based clotting may be influenced by the assay and device used. For the FF assay, data are lacking.

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