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Journal of Pharmacology and Medicinal Chemistry

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The role of viscoelastic tests in trauma: “TEG and ROTEM”

Author(s): Ayten Saraçoğlu*, Ayşen Yarat and Şermin Tetik

BACKGROUND: Each year, 5.8 million people die as a result of trauma. Uncontrolled bleeding and inappropriate policies applied for patient blood management play a significant role in most of these deaths.

METHOD: Hemostasis may become more problematic in the presence of trauma. Trauma induced coagulopathy (TIC), known as “blood vicious tiriad”, is characterized with acidosis, hypothermia, increased platelet number and coagulation factors. TIC, which has been related to several mechanisms, originates from platelet dysfunction, hyperfibrinolysis, endothelial dysfunction and hypo-dysfibrinogenemia. So hemorrhage monitoring is crucial for planning patient-specific transfusion and avoiding undesirable effects of excessive volume load. The monitoring procedure starts with anamnesis and continues with laboratory tests.

RESULTS: The laboratory tests routinely applied for the analysis of coagulation do not reveal the risk of hemorrhage, and it is obvious that blood and blood products used as prophylactic agents may have an additive effect especially on bleeding. Moreover, it was indicated that prothrombin time (PT) and partial thromboplastin time (PTT) are badly correlated with acute resuscitation efforts, and patients experience shock deteriorating secondary to consecutive massive transfusion. Classical tests give information about the period until formation of thrombin which constitutes 5% of the whole process. However, they do not give information about the interaction of endothelium, thrombocyte and enzymes with cell phospholipids, clot quality and fibrinolysis.

DISCUSSION: Point of care (POC) tests such as Thromboelastography (TEG) and Rotational thromboelastometry (ROTEM) evaluate all thrombin mediated processes. They have a unique ability to measure the development of blood clots and the strength of the platelet-fibrin bond and allow observation of the internal interactions in blood and the contributions of cellular content. If the coagulation cascade was to be compared with a house construction, conventional tests would represent the time until the first basis of the house is laid while TEG and ROTEM show how fast the house is built and how strong the construction is. ROTEM and TEG, indeed, depend on the same principles and give the same graph, but ROTEM has some differences compared to TEG. Considering that the turnaround time, the timing of bedside tests seems to be more appropriate for perioperative bleeding monitoring.

CONCLUSION: The utilization of POC tests reduces the incidence of unnecessary blood product transfusion; and consequently leads to a reduction in mortality, morbidity, and cost in traumatic patients.

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