Schochl also reported that hyperfibrinolysis, detected by ROTEM® ML correlated with higher mortality and this parameter could be used to classify the degree of severity of the fibrinolysis . In 2010 Kashuk et al found that abnormal primary lysis detected by elevated CL (similar to ROTEM® ML) is also associated with mortality . As summarized on Table 2, these 11 studies showed that some TEG® and ROTEM® parameters are similarly associated with outcomes in trauma. TEG® MA and ROTEM® MCF are associated with both the
need for blood transfusion and mortality, while excessive fibrinolysis diagnosed by either TEG® CL or ROTEM® ML are independent predictors of mortality. Discussion A few deductions can be promptly reached from reviewing the literature on these two viscoelastic Selleckchem Tamoxifen tests. First that there is a lot of enthusiasm supporting their clinical application in trauma. The literature suggests that both tests are already being used in many institutions, which could be in a wider scale than suggested by the limited number of publications. The wide clinical
application of any technology without supporting evidence and scientific validation is worrisome and more investigations on these tests are urgently needed and warranted. Another plausible conclusion from this review is that the prevalent notion that the two tests are equivalent with interchangeable results Alvelestat cell line and interpretations may be unfounded. While there are insufficient studies to support any conclusions on the topic, the current evidence indicates only a small number of similarities between the tests. Concerning their diagnostic capacity, the similarities found were limited to TEG® MA and ROTEM® MCF and their similar association with platelet count and PTT. Another
apparent similarity was of TEG® CL and ROTEM® ML in diagnosing excessive fibrinolysis and mortality (prognosis). Prognostication was where these tests showed more similarities. TEG® MA and ROTEM MCF® were also linked to the need for blood transfusion and mortality. The few studies on TEG®- or ROTEM®-based transfusion algorithms Baricitinib suggested that while both tests can be used to construct transfusion guidelines, the blood products transfused differ according to the algorithm selected. Even tough no study could be found directly comparing TEG® and ROTEM® in trauma; two studies have compared the 2 tests in transplant and cardiac surgery. Coakley et al., in the liver transplant study concluded that transfusion practice could differ depending on the visco-elastic coagulation-monitoring device in use. Venema et al., verified that kaolin-activated TEG® measurements correlated with those of EXTEM®, but not all the measurements of the two devices are interchangeable. These findings seem to support the concept that despite similarities, interchangeable interpretation is not recommended without further studies and standardizations.