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Review
. Jul-Sep 2017;15(3):380-385.
doi: 10.1590/S1679-45082017MD3130. Epub 2017 Jun 12.

A New Era of Thromboelastometry

[Article in English, Portuguese]
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Free PMC article
Review

A New Era of Thromboelastometry

[Article in English, Portuguese]
Tomaz Crochemore et al. Einstein (Sao Paulo). .
Free PMC article

Abstract

Severe hemorrhage with necessity of allogeneic blood transfusion is common complication in intensive care unit and is associated with increased morbidity and mortality. Prompt recognition and treatment of bleeding causes becomes essential for the effective control of hemorrhage, rationalizing the use of allogeneic blood components, and in this way, preventing an occurrence of their potential adverse effects. Conventional coagulation tests such as prothrombin time and activated partial thromboplastin time present limitations in predicting bleeding and guiding transfusion therapy in critically ill patients. Viscoelastic tests such as thromboelastography and rotational thromboelastometry allow rapid detection of coagulopathy and goal-directed therapy with specific hemostatic drugs. The new era of thromboelastometry relies on its efficacy, practicality, reproducibility and cost-effectiveness to establish itself as the main diagnostic tool and transfusion guide in patients with severe active bleeding.

A hemorragia grave com necessidade de transfusão de sangue e componentes é uma complicação frequente na unidade de terapia intensiva e está associada ao aumento da morbidade e da mortalidade. A identificação adequada e o tratamento precoce da causa específica da coagulopatia tornam-se fundamentais para o controle efetivo da hemorragia, racionalizando a utilização de sangue e componentes, e desta forma, prevenindo a ocorrência de efeitos adversos. Testes convencionais da coagulação (tempo de ativação de protrombina e tempo de tromboplastina parcial ativada) apresentam limitações para prever sangramento e guiar a terapia transfusional em pacientes graves. Testes viscoelásticos como a tromboelastografia e tromboelastometria rotacional permitem a rápida detecção da coagulopatia e orientam a terapia de forma individualizada, alvo dirigida com drogas hemostáticas específicas. A nova era da tromboelastometria confia na sua eficácia, praticidade, reprodutibilidade e custo-eficácia para se firmar como a principal ferramenta diagnóstica e guia transfusional em pacientes com sangramento ativo grave.

Figures

Figure 1
Figure 1. Schematic representation of analysis with rotational thromboelastometry
Figure 2
Figure 2. Rotational thromboelastometry parameters
Figure 3
Figure 3. Graphic representation of the different channels (INTEM, EXTEM, and FIBTEM) of rotational thromboelastometry
Figure 4
Figure 4. Diagnostic algorithm guided by rotational thromboelastometry

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