Viscoelastic tests allow a reduction in blood product transfusion. Three modern devices are currently available (rotational thromboelastometry [ROTEM] sigma, thromboelastography [TEG] 6S, and Quantra). No study has compared the performances of these 3 devices simultaneously.
An observational, nonrandomized cohort study.
A single-center of cardiac surgery in a university hospital.
A total of 30 consecutive measurements from at least 10 adult patients presenting significant bleeding in the intensive care unit after cardiac surgery
Viscoelastic tests using ROTEM sigma, TEG 6S, and Quantra were performed concomitantly with conventional coagulation measurements
Measurements and Main Results
The authors included 16 patients with 31 blood samples. After the exclusion of missing values, 27 samples were analyzed. Correlation with platelet count was as follows: ROTEM, r = 0.84 [0.66-0.93], p < 0.0001; Quantra, r = 0.83 [0.64-0.92], p < 0.0001; TEG 6S, r = 0.64 [0.29-0.83], p = 0.001. Correlation with fibrinogen (Clauss assay) was as follows: ROTEM, r = 0.85 [0.68-0.93], p < 0.0001; Quantra, r = 0.88 [0.74-0.95], p < 0.0001; TEG 6S, r = 0.79 [0.55-0.91], p < 0.0001. No difference was observed for the detection of residual circulating heparin (anti-Xa activity >0.1), with 87% of correct identification for Quantra and 80% for both ROTEM and TEG 6S (p = 0.3). Time to first results after the beginning of the test was shorter for Quantra than ROTEM and TEG 6S (136 [126-152] seconds v 205 [176-221] seconds, p = 0.003 and v 450 [372-516] seconds, p < 0.0001 respectively).
ROTEM sigma, TEG 6S, and Quantra performed similarly for exploring platelet count or residual circulating heparin. Thromboelastography 6S presented a weaker correlation with fibrinogen Clauss.
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- 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery.J Cardiothorac Vasc Anesth. 2018; 32 (Task Force on Patient Blood Management for Adult Cardiac Surgery of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Cardiothoracic Anaesthesiology (EACTA)): 88-120
- Viscoelastic hemostatic assays: Moving from the laboratory to the site of care-a review of established and emerging technologies.Diagnostics (Basel). 2020; 10: E118
- [Thrombelastography, a method for physical analysis of blood coagulation].Z Gesamte Exp Med. 1951; 117: 189-203
- Point-of-care hemostatic testing in cardiac surgery: A stepped-wedge clustered randomized controlled trial.Circulation. 2016; 134: 1152-1162
- Viscoelastic blood tests use in adult cardiac surgery: Meta-analysis, meta-regression, and trial sequential analysis.J Cardiothorac Vasc Anesth. 2020; 34: 119-127
- Routine use of viscoelastic blood tests for diagnosis and treatment of coagulopathic bleeding in cardiac surgery: Updated systematic review and meta-analysis.Br J Anaesth. 2017; 118: 823-833
- Management of hemorrhage in cardiothoracic surgery.J Cardiothorac Vasc Anesth. 2013; 27: S20-S34
- A novel device for the evaluation of hemostatic function in critical care Settings.Anesth Analg. 2016; 123: 1372-1379
- SEER sonorheometry versus rotational thromboelastometry in large volume blood loss spine surgery.Anesth Analg. 2016; 23: 1380-1389
- A comparison of a new ultrasound-based whole blood viscoelastic test (SEER Sonorheometry) versus thromboelastography in cardiac surgery.Anesth Analg. 2016; 123: 1400-1407
- Comparison of SEER sonorheometry with rotational thromboelastometry and laboratory parameters in cardiac surgery.Anesth Analg. 2016; 123: 1390-1399
- A Comparative study of SEER sonorheometry versus standard coagulation tests, rotational thromboelastometry, and multiple electrode aggregometry in cardiac surgery.J Cardiothorac Vasc Anesth. 2019; 33: 1590-1598
- French legal approach to patient consent in clinical research.Anaesth Crit Care Pain Med. 2020; 39: 883-885
- Cost-effectiveness of point-of-care viscoelastic haemostatic assays in the management of bleeding during cardiac surgery: Protocol for a prospective multicentre pragmatic study with stepped-wedge cluster randomised controlled design and 1-year follow-up (the IMOTEC study).BMJ Open. 2019; 9e029751
- 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery.Br J Anaesth. 2019; 23 (Authors/Task Force Members): 713-757
- Position of the French Working Group on Perioperative Haemostasis (GIHP) on viscoelastic tests: What role for which indication in bleeding situations?.Anaesth Crit Care Pain Med. 2019; 38: 539-548
- Assessing the methodology for calculating platelet contribution to clot strength (platelet component) in thromboelastometry and thrombelastography.Anesth Analg. 2015; 121: 868-878
- Comparison of the resonance sonorheometry based Quantra system with rotational thromboelastometry ROTEM sigma in cardiac surgery - a prospective observational study.BMC Anesthesiol. 2012; 21: 260
- Marked changes in platelet count and function following pediatric congenital heart surgery.Pediatric Anesthesia. 2014; 24: 386-392
- Multicenter evaluation of the Quantra QPlus system in adult patients undergoing major surgical procedures.Anesth Analg. 2020; 130: 899-909
- Platelet contribution to clot strength in thromboelastometry: Count, function, or both?.Platelets. 2020; 31: 88-93
- TEG 6s system measures the contributions of both platelet count and platelet function to clot formation at the site-of-care.Platelets. 2020; 31: 932-938
- Assessment of agreement and interchangeability between the TEG5000 and TEG6S thromboelastography haemostasis analysers: A prospective validation study.BMC Anesthesiol. 2019; 19: 45
- Sensitivity of viscoelastic tests to platelet function.J Clin Med. 2020; 9: E189
- Transfusion requirements in elective cardiopulmonary bypass surgery patients: Predictive value of Multiplate and Thromboelastography (TEG) Platelet Mapping Assay.Scand J Clin Lab Invest. 2017; 77: 345-351
- U-shaped relationship between pre-operative plasma fibrinogen levels and severe peri-operative bleeding in cardiac surgery.Eur J Anaesthesiol. 2020; 37: 889-897
- The relationship between fibrinogen levels after cardiopulmonary bypass and large volume red cell transfusion in cardiac surgery: An observational study.Anesth Analg. 2013; 117: 14-22
- Comparison between the new fully automated viscoelastic coagulation analysers TEG 6s and ROTEM Sigma in trauma patients: A prospective observational study.Eur J Anaesthesiol. 2019; 36: 834-842
- Trials and tribulations of viscoelastic-based determination of fibrinogen concentration.Anesth Analg. 2020; 130: 644-653
- FIBTEM PLUS provides an improved thromboelastometry test for measurement of fibrin-based clot quality in cardiac surgery patients.Anesth Analg. 2013; 17: 1054-1062
- Thromboelastography and thromboelastometry in assessment of fibrinogen deficiency and prediction for transfusion requirement: A Descriptive review.Biomed Res Int. 2018; 7020539
- Prediction of post-weaning fibrinogen status during cardiopulmonary bypass: An observational study in 110 patients.PLoS One. 2015; 10e0126692
- Fibrinogen measurement in cardiac surgery with cardiopulmonary bypass: Analysis of repeatability and agreement of Clauss method within and between six different laboratories.Thromb Haemost. 2014; 112: 109-117
- The role of fibrinogen and fibrinogen concentrate in cardiac surgery: An international consensus statement from the Haemostasis and Transfusion Scientific Subcommittee of the European Association of Cardiothoracic Anaesthesiology.Anaesthesia. 2019; 74: 1589-1600
- Association of plasma fibrinogen and thromboelastography with blood loss in complex cardiac surgery.Clin Appl Thromb Hemost. 2021; 2710760296211016540
Published online: February 21, 2023
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