Timothy Carll, Geoffrey D Wool
BACKGROUND: Viscoelastic testing is a method of hemostatic analysis that provides a real-time, holistic view of ex vivo clotting. It allows for examination of both cellular and plasma protein contributions to clotting including platelet number and function, fibrin(ogen) function, and coagulation factor function. The method assesses physical clot properties during the transition of blood from a liquid to a gel state, either by measurement of clot shear modulus using physical force transduction or by measurement of clot resonance frequency using sonometric interrogation...
October 2020: Transfusion
Tetsuro Sakai
Despite the lack of large randomized clinical studies, viscoelastic tests (VETs) have been a critical armamentarium for hemostatic control in liver transplantation (LT) since the 1960s. Many transplant institutions have adopted VETs in their clinical practice. Several small-size randomized clinical trials on LT patients have suggested that VET-guided hemostatic treatment algorithms have led to decreased indications for and amounts of transfused blood products, especially fresh-frozen plasma, compared to standard laboratory-based hemostatic management...
October 2020: Transfusion
Alexandra Dixon, Samantha Underwood, Martin Schreiber
Viscoelastic hemostatic assays such as thrombelastography (TEG) and rotational thrombelastometry have proven to be important point-of-care tools in the management of acute traumatic hemorrhage. Despite the availability of prospective studies that have confirmed the utility of TEG in reducing transfusion requirements and mortality in bleeding patients when compared to conventional coagulation tests, many institutions run into barriers implementing these viscoelastic hemostatic assays due to concerns regarding cost and benefit...
October 2020: Transfusion
Melissa K Mattson, Cory Groves, Mark M Smith, Jon M Christensen, Dong Chen, James R Stubbs, Brad S Karon, Gregory A Nuttall
Platelet (PLT) transfusions are an important component of hemostatic resuscitation. The AABB has published several guidelines recommending that PLT units should not be infused through blood warming devices. STUDY DESIGN AND METHODS: Thirty-one units of hospital blood bank apheresis PLTs were obtained. PLT-rich plasma (PRP) aggregometry and thromboelastography (TEG) were performed on the unit samples before and after the units were infused through a Ranger blood/fluid warming device. RESULTS: There were no differences in any of the aggregometry results before and after infusion of the PLTs through the blood warmer (all P > ...
October 19, 2020: Transfusion
Tomaz Crochemore, Felício Aragão Savioli, João Carlos de Campos Guerra, Erika Maria do Nascimento Kalmar
This case report a severe case of yellow fever complicated by liver failure and disseminated intravascular coagulation. Thromboelastometry was capable of identifying clotting disorders and guiding hemostatic therapy. We report the case of a 23-year-old male admitted to the Intensive Care Unit with sudden onset of fever, generalized muscle pain associated with liver failure, and disseminated intravascular coagulation. The results of conventional laboratory tests showed thrombocytopenia, whereas thromboelastometry suggested coagulopathy with slight hypofibrinogenemia, clotting factor consumption, and, consequently, an increased risk of bleeding...
July 2020: Revista Brasileira de Terapia Intensiva
Giles Lawrence Devaney, Kate Louise King, Zsolt Janos Balogh
PURPOSE: Angioembolization (AE) has been questioned as first-line modality for hemorrhage control of pelvic fracture (PF)-associated bleeding due to its potential inconsistent timely availability. We aimed to describe the patterns of AE use with hemostatic resuscitation and hypothesized that time to AE improved during the study period. METHODS: A Level-1 trauma center's prospective PF database was analyzed. All consecutive PFs referred to angiography between 01/01/2009 and 12/31/2018 were included...
October 9, 2020: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Xing-Chen Zhang, Ma-Ji Sun, Sheng Pan, Min Rui, Feng-Chao Zhao, Guo-Chun Zha, Yong Pang, Xin Zheng, Kai-Jin Guo
OBJECTIVE: Despite the wide use of tranexamic acid (TXA) in the perioperative period of total hip arthroplasty (THA), whether the hemostatic state changes after the application of intravenous (IV)-TXA are still unknown. The aim of this study was to investigate whether IV administration of TXA changes the blood coagulation following primary THA via thrombelastography (TEG) analysis and conventional laboratory tests. METHODS: A total of 174 patients who underwent primary THA from September 2016 to July 2018 were selected...
September 2020: Journal of Orthopaedic Surgery
Christopher R Reed, Desiree Bonadonna, Jeffrey Everitt, Victoria Robinson, James Otto, Elisabeth T Tracy
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used to support patients with reversible cardiopulmonary insufficiency. Although it is a lifesaving technology, bleeding, inflammation, and thrombosis are well-described complications of ECMO. Adult porcine models of ECMO have been used to recapitulate the physiology and hemostatic consequences of ECMO cannulation in adults. However, these models lack the unique physiology and persistence of fetal forms of coagulation factors and fibrinogen as in human infants...
September 2020: Journal of Extra-corporeal Technology
Zhaoxin Qian, Fang Xiong, Xiaozhe Xia, Pengjuan Gu, Qinghong Wang, Aiping Wu, Qianyi Gong, Huan Zhang, Yi Chen, Wendong Chen
Aim:  To assess the impact of oxidized regenerated cellulose (ORC) on blood transfusion and hospital costs associated with surgeries. Patients & methods: This retrospective cohort study selected ten surgeries to create propensity-score matching groups to compare ORC versus nonORC (conventional hemostatic techniques such as manual pressure, ligature and electrocautery). Results: NonORC was associated with both higher blood transfusion volume and higher hospital costs than ORC in endoscopic transnasal sphenoidal surgery, nonskull base craniotomy, hepatectomy, cholangiotomy, gastrectomy and lumbar surgery...
September 22, 2020: Journal of Comparative Effectiveness Research
Nikolay Bugaev, John J Como, Guy Golani, Jennifer J Freeman, Jaswin S Sawhney, Cory J Vatsaas, Brian K Yorkgitis, Laura A Kreiner, Nicole M Garcia, Hiba Abdel Aziz, Peter A Pappas, Eric J Mahoney, Zachary W Brown, George Kasotakis
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: 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 to non-TEG/ROTEM-guided blood products transfusions strategies were performed...
September 16, 2020: Journal of Trauma and Acute Care Surgery
Natasha Janko, Ammar Majeed, William Kemp, Stuart K Roberts
Viscoelastic point-of-care (VET POC) tests provide a global assessment of hemostasis and have an increasing role in the management of bleeding and blood component delivery across several clinical settings. VET POC tests have a rapid turnaround time, provide a better overall picture of hemostasis, predict bleeding more accurately than conventional coagulation tests, and reduce blood component usage and health care costs. Despite commonly having abnormal conventional coagulation tests, most patients with chronic liver disease have a "rebalanced" hemostasis...
September 2020: Seminars in Thrombosis and Hemostasis
Christine M Leeper, Mark H Yazer, Darrell J Triulzi, Matthew D Neal, Barbara A Gaines
OBJECTIVE: To compare a propensity-matched cohort of injured children receiving conventional blood component transfusion to injured children receiving low-titer group O negative whole blood. SUMMARY OF BACKGROUND DATA: Transfusion of whole blood in pediatric trauma patients is feasible and safe. Effectiveness has not been evaluated. METHODS: Injured children ≥1 years old can receive up to 40 mL/kg of cold-stored, uncrossmatched whole blood during initial hemostatic resuscitation...
October 2020: Annals of Surgery
Mario Cruciani, Massimo Franchini, Carlo Mengoli, Giuseppe Marano, Ilaria Pati, Francesca Masiello, Eva Veropalumbo, Simonetta Pupella, Stefania Vaglio, Vanessa Agostini, Giancarlo Maria Liumbruno
Hemostatic resuscitation is currently considered a standard of care for the management of life-threatening hemorrhage, but in some critical settings the access to high quantities of blood components is problematic. Whole blood (WB) transfusion has been proposed as an alternative modality for hemostatic resuscitation of traumatic major bleeding. To assess the efficacy and safety of WB in trauma-associated massive bleeding, we performed a systematic review of the literature. We selected studies comparing WB transfusions to transfusion of blood components (COMP) in massive trauma bleeding; both randomized clinical trial (RCT) and observational studies were considered...
September 15, 2020: Internal and Emergency Medicine
Alexander C Schulick, Hunter B Moore, Carson B Walker, Hillary Yaffe, James J Pomposelli, Fareed Azam, Michael Wachs, Thomas Bak, Peter Kennealey, Kendra Conzen, Megan Adams, Thomas Pshak, Rashikh Choudhury, Michael P Chapman, Elizabeth A Pomfret, Trevor L Nydam
BACKGROUND: An NIH clinical coagulopathy score has been devised for trauma patients, but no such clinical score exists in transplantation surgery. We hypothesize that that this coagulopathy score can effectively identify laboratory defined coagulopathy during liver transplantation and correlates to blood product utilization. METHODS: TEGs were performed and coagulopathy scores (1, normal bleeding - 5, diffuse coagulopathic bleeding) were assigned by the surgeons at 5 intra-operative time points...
September 1, 2020: American Journal of Surgery
Adriana Alméciga, Juliana Rodriguez, Julián Beltrán, James Sáenz, Abel Merchán, Jorge Egurrola, Javier Burbano, Lina Trujillo, Fernando Heredia, René Pareja
PURPOSE: Locally advanced cervical cancer may present with uncontrollable vaginal bleeding in up to 70% of cases. Pelvic vessel embolization has been used as an urgent maneuver for achieving fast hemostatic control. This report describes outcomes of selective pelvic vessel embolization in patients with severe bleeding due to a locally advanced cervical cancer. METHODS: In this retrospective study, technical aspects, clinical variables, and bleeding-related morbidity were described...
September 2020: JCO global oncology
Geir Strandenes, Joar Sivertsen, Christopher K Bjerkvig, Theodor K Fosse, Andrew P Cap, Deborah J Del Junco, Einar Klæboe Kristoffersen, Rune Haaverstad, Venny Kvalheim, Hanne Braathen, Turid Helen Felli Lunde, Tor Hervig, Karl Ove Hufthammer, Philip C Spinella, Torunn Oveland Apelseth
BACKGROUND: This pilot trial focused on feasibility and safety to provide preliminary data to evaluate the hemostatic potential of cold-stored platelets (2° to 6°C) compared with standard room temperature-stored platelets (20° to 24°C) in adult patients undergoing complex cardiothoracic surgery. This study aimed to assess feasibility and to provide information for future pivotal trials. METHODS: A single center two-stage exploratory pilot study was performed on adult patients undergoing elective or semiurgent complex cardiothoracic surgery...
September 9, 2020: Anesthesiology
Johannes Gratz, Daniel Oberladstätter, Herbert Schöchl
Hemorrhage after trauma remains a significant cause of preventable death. Trauma-induced coagulopathy (TIC) at the time of hospital admission is associated with an impaired outcome. Rather than a universal phenotype, TIC represents a complex hemostatic disorder, and standard coagulation tests are not designed to adequately reflect the complexity of TIC. Viscoelastic testing (VET) has gained increasing interest for the characterization of TIC because it provides a more comprehensive depiction of the coagulation process...
September 7, 2020: Hämostaseologie
Seyed Musaal-Reza Hosseini, Malihe Dadgar Moghaddam, Samaneh Yazdan Panah, Jamshid Vafaeimanesh
Background: From many years ago, gastric lavage has been one of the main pillars of the classic treatment for upper gastrointestinal bleeding (UGIB). The present study investigated the effect of gastric lavage with hemostatic powder on the UGIB complications. Methods: This clinical trial study was performed on 54 patients who referred to the emergency department during 2017-2018. The subjects were divided into two groups (n=27 per group). Gastric lavage with saline and hemostasis powder® was performed in the control and experimental groups, respectively...
May 2020: Caspian Journal of Internal Medicine
Ryann S Lauby, Sarah A Johnson, Matthew A Borgman, James Bynum, Guyon J Hill, Steven G Schauer
Background: Hemorrhage is one of the leading causes of preventable death in both military and civilian trauma. Implementation of items such as tourniquets and hemostatic dressings are helpful in controlling hemorrhage and increasing the survival rate of casualties when such injuries occur. Prehospital blood transfusions are used to treat patients with severe injuries where the standard methods of hemorrhage control are not an effective form of treatment. There is limited research and no widely accepted protocol on pediatric prehospital blood transfusions...
September 1, 2020: Prehospital Emergency Care
Robert H Lee, Raj S Kasthuri, Wolfgang Bergmeier
PURPOSE OF REVIEW: In this review, we discuss current clinical guidelines and potential underlying mechanisms regarding platelet transfusion therapy in patients at risk of bleeding, comparing management of patients with thrombocytopenia versus those with qualitative platelet disorders. RECENT FINDINGS: Platelet transfusion therapy is highly effective in managing bleeding in patients with hypoproliferative thrombocytopenia. Clinical trials have demonstrated that platelet transfusion can be used at a lower trigger threshold and reduced platelet doses, and may be used therapeutically rather than prophylactically in some situations, although additional data are needed...
November 2020: Current Opinion in Hematology
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