Basic Principles of Rotational Thromboelastometry (ROTEM<sup>®</sup>) and the Role of ROTEM—Guided Fibrinogen Replacement Therapy in the Management of Coagulopathies
Rotational thromboelastometry (ROTEM) is a viscoelastic method, which provides a graphical and numerical representation of induced hemostasis in whole blood samples. Its ability to quickly assess the state of hemostasis is used in the management of bleeding from a variety of causes. The separate act...
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| Format: | Article |
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MDPI AG
2023-10-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/13/20/3219 |
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| author | Miroslava Drotarova Jana Zolkova Kristina Maria Belakova Monika Brunclikova Ingrid Skornova Jan Stasko Tomas Simurda |
| author_facet | Miroslava Drotarova Jana Zolkova Kristina Maria Belakova Monika Brunclikova Ingrid Skornova Jan Stasko Tomas Simurda |
| author_sort | Miroslava Drotarova |
| collection | DOAJ |
| description | Rotational thromboelastometry (ROTEM) is a viscoelastic method, which provides a graphical and numerical representation of induced hemostasis in whole blood samples. Its ability to quickly assess the state of hemostasis is used in the management of bleeding from a variety of causes. The separate activation of particular parts of hemocoagulation in INTEM, EXTEM, and FIBTEM tests allows for a more comprehensive and faster evaluation of the missing component of hemostasis followed by targeted therapy. One of the most common cause of coagulopathy is trauma-induced coagulopathy. Fibrinogen replacement therapy by ROTEM allows for the use of a standard dosage of fibrinogen, which has been shown to be successful in preventing dilutional coagulopathy following colloid and crystalloid replacement and excessive amount of allogeneic blood transfusions. The best reflection of fibrinogen activity is observed in the FIBTEM assay, where fibrinogen replacement therapy is recommended at an MCF (maximum clot firmness) of FIBTEM < 10 mm and FIBTEM A10 < 7 mm. ROTEM also plays an important role in the diagnostic and management of inherited fibrinogen disorders. These can be manifested by bleeding complications, where changes in the MCF parameter are the most useful tool for assessing the effectiveness of fibrinogen replacement therapy. ROTEM-guided bleeding management algorithms effectively reduce the number of transfusions, healthcare costs, and complications, leading to the improvement of patient safety and overall health. |
| first_indexed | 2024-03-10T21:18:55Z |
| format | Article |
| id | doaj.art-b59dfeee6170445ba1ab50d5dda803f4 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T21:18:55Z |
| publishDate | 2023-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-b59dfeee6170445ba1ab50d5dda803f42023-11-19T16:12:58ZengMDPI AGDiagnostics2075-44182023-10-011320321910.3390/diagnostics13203219Basic Principles of Rotational Thromboelastometry (ROTEM<sup>®</sup>) and the Role of ROTEM—Guided Fibrinogen Replacement Therapy in the Management of CoagulopathiesMiroslava Drotarova0Jana Zolkova1Kristina Maria Belakova2Monika Brunclikova3Ingrid Skornova4Jan Stasko5Tomas Simurda6National Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin, University Hospital in Martin, Comenius University in Bratislava, 036 01 Martin, SlovakiaNational Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin, University Hospital in Martin, Comenius University in Bratislava, 036 01 Martin, SlovakiaNational Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin, University Hospital in Martin, Comenius University in Bratislava, 036 01 Martin, SlovakiaNational Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin, University Hospital in Martin, Comenius University in Bratislava, 036 01 Martin, SlovakiaNational Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin, University Hospital in Martin, Comenius University in Bratislava, 036 01 Martin, SlovakiaNational Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin, University Hospital in Martin, Comenius University in Bratislava, 036 01 Martin, SlovakiaNational Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Jessenius Faculty of Medicine in Martin, University Hospital in Martin, Comenius University in Bratislava, 036 01 Martin, SlovakiaRotational thromboelastometry (ROTEM) is a viscoelastic method, which provides a graphical and numerical representation of induced hemostasis in whole blood samples. Its ability to quickly assess the state of hemostasis is used in the management of bleeding from a variety of causes. The separate activation of particular parts of hemocoagulation in INTEM, EXTEM, and FIBTEM tests allows for a more comprehensive and faster evaluation of the missing component of hemostasis followed by targeted therapy. One of the most common cause of coagulopathy is trauma-induced coagulopathy. Fibrinogen replacement therapy by ROTEM allows for the use of a standard dosage of fibrinogen, which has been shown to be successful in preventing dilutional coagulopathy following colloid and crystalloid replacement and excessive amount of allogeneic blood transfusions. The best reflection of fibrinogen activity is observed in the FIBTEM assay, where fibrinogen replacement therapy is recommended at an MCF (maximum clot firmness) of FIBTEM < 10 mm and FIBTEM A10 < 7 mm. ROTEM also plays an important role in the diagnostic and management of inherited fibrinogen disorders. These can be manifested by bleeding complications, where changes in the MCF parameter are the most useful tool for assessing the effectiveness of fibrinogen replacement therapy. ROTEM-guided bleeding management algorithms effectively reduce the number of transfusions, healthcare costs, and complications, leading to the improvement of patient safety and overall health.https://www.mdpi.com/2075-4418/13/20/3219rotational thromboelastometrymanagementfibrinogen disordersfibrinogen replacement therapy |
| spellingShingle | Miroslava Drotarova Jana Zolkova Kristina Maria Belakova Monika Brunclikova Ingrid Skornova Jan Stasko Tomas Simurda Basic Principles of Rotational Thromboelastometry (ROTEM<sup>®</sup>) and the Role of ROTEM—Guided Fibrinogen Replacement Therapy in the Management of Coagulopathies Diagnostics rotational thromboelastometry management fibrinogen disorders fibrinogen replacement therapy |
| title | Basic Principles of Rotational Thromboelastometry (ROTEM<sup>®</sup>) and the Role of ROTEM—Guided Fibrinogen Replacement Therapy in the Management of Coagulopathies |
| title_full | Basic Principles of Rotational Thromboelastometry (ROTEM<sup>®</sup>) and the Role of ROTEM—Guided Fibrinogen Replacement Therapy in the Management of Coagulopathies |
| title_fullStr | Basic Principles of Rotational Thromboelastometry (ROTEM<sup>®</sup>) and the Role of ROTEM—Guided Fibrinogen Replacement Therapy in the Management of Coagulopathies |
| title_full_unstemmed | Basic Principles of Rotational Thromboelastometry (ROTEM<sup>®</sup>) and the Role of ROTEM—Guided Fibrinogen Replacement Therapy in the Management of Coagulopathies |
| title_short | Basic Principles of Rotational Thromboelastometry (ROTEM<sup>®</sup>) and the Role of ROTEM—Guided Fibrinogen Replacement Therapy in the Management of Coagulopathies |
| title_sort | basic principles of rotational thromboelastometry rotem sup r sup and the role of rotem guided fibrinogen replacement therapy in the management of coagulopathies |
| topic | rotational thromboelastometry management fibrinogen disorders fibrinogen replacement therapy |
| url | https://www.mdpi.com/2075-4418/13/20/3219 |
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