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Zátroch I, Dinya E, Fazakas J. New under the sun: ClotPro's ECA-test detects hyperfibrinolysis in a higher number of patients, more frequently and 9 min earlier. Blood Coagul Fibrinolysis 2023; 34:99-104. [PMID: 36519572 PMCID: PMC9894133 DOI: 10.1097/mbc.0000000000001185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/25/2022] [Indexed: 12/23/2022]
Abstract
Liver diseases result in a re-balanced state of the haemostatic system with decreased haemostatic reserves. Increased fibrinolytic activity is commonly seen during liver transplants. The aim of this study was to assess whether ClotPro's ECA-test is able to detect hyperfibrinolysis earlier and with higher frequency than ClotPro's conventional viscoelastic assays for the intrinsic and the extrinsic coagulation pathway. From 25 liver transplant recipients, systemic blood samples were collected during surgery. Viscoelastic haemostatic assays with ClotPro's IN-test, EX-test and ECA-test were performed simultaneously from each blood sample. Hyperfibrinolysis was defined on the basis of the manufacturer's prespecified threshold value (maximal lysis >15%). The incidence of hyperfibrinolysis detected with each test was compared with the McNemar test. For each assay, lysis detection time (LDT) was calculated and analysed with the nonparametric Kruskal-Wallis test. A total of 125 tests were performed simultaneously. Compared with the IN-test and the EX-test, the ECA-test detected hyperfibrinolysis in significantly ( P < 0.001) higher number of patients (9; 11; 14, respectively) and in more measurement points (14; 18; 28, respectively). The analysis of LDT values revealed significant superiority of the ECA-test to the IN-test ( P = 0.046) and to the EX-test ( P = 0.035), indicating the profibrinolytic state of the haemostasis 8.9 ± 0.65 and 8.7 ± 0.17 min earlier, respectively. These are preliminary results of the study NCT0424637. ClotPro's ECA-test appeared to detect fibrinolysis in a higher number of patients, more frequently, and the mean time of detection was 9 min earlier than that of the IN-test and the EX-test.
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Affiliation(s)
- István Zátroch
- Department of Anesthesiology and Intensive Therapy, Uzsoki Hospital
| | - Elek Dinya
- Institute of Digital Health Sciences, Semmelweis University
| | - János Fazakas
- Department of Surgery, Transplantation and Intervetional Gastroenterology and Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
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2
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Assessing Plasmin Generation in Health and Disease. Int J Mol Sci 2021; 22:ijms22052758. [PMID: 33803235 PMCID: PMC7963172 DOI: 10.3390/ijms22052758] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/20/2021] [Accepted: 03/05/2021] [Indexed: 12/13/2022] Open
Abstract
Fibrinolysis is an important process in hemostasis responsible for dissolving the clot during wound healing. Plasmin is a central enzyme in this process via its capacity to cleave fibrin. The kinetics of plasmin generation (PG) and inhibition during fibrinolysis have been poorly understood until the recent development of assays to quantify these metrics. The assessment of plasmin kinetics allows for the identification of fibrinolytic dysfunction and better understanding of the relationships between abnormal fibrin dissolution and disease pathogenesis. Additionally, direct measurement of the inhibition of PG by antifibrinolytic medications, such as tranexamic acid, can be a useful tool to assess the risks and effectiveness of antifibrinolytic therapy in hemorrhagic diseases. This review provides an overview of available PG assays to directly measure the kinetics of plasmin formation and inhibition in human and mouse plasmas and focuses on their applications in defining the role of plasmin in diseases, including angioedema, hemophilia, rare bleeding disorders, COVID-19, or diet-induced obesity. Moreover, this review introduces the PG assay as a promising clinical and research method to monitor antifibrinolytic medications and screen for genetic or acquired fibrinolytic disorders.
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Comparison of citrated and fresh whole blood for viscoelastic coagulation testing during elective neurosurgery. Thromb Res 2017; 156:73-79. [PMID: 28601642 DOI: 10.1016/j.thromres.2017.05.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 05/11/2017] [Accepted: 05/29/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Previous viscoelastic haemostatic tests studies have often indicated a hypercoagulative test signal with citrated blood, which could influence clinical decision makings. PURPOSE The aim of this study was to compare fresh and citrated whole blood using two non-automated viscoelastic ROTEM and Sonoclot tests. Our hypothesis was that citrated blood would demonstrate a hypercoagulative response in this setting, not tested before. METHODS Perioperative viscoelastic coagulation changes were evaluated with a ROTEM and Sonoclot in 38 patients undergoing elective brain tumor surgery. The citrated samples were recalcified with CaCl2. Wilcoxon nonparametric-paired tests and Bland-Altman plots were performed to compare the fresh and citrated blood analyses. RESULTS The citrated blood showed a hypercoagulative response in ROTEM NATEM-clot formation time and α-angle, Sonoclot-clot rate and platelet function, as compared to fresh blood (p<0.0001). CONCLUSIONS Fresh whole blood may theoretically reflect in vivo haemostasis more closely than citrated analyses, which indicated a hypercoagulative response as compared to the fresh whole blood analyses Bland-Altman plots also indicated that ROTEM reference ranges in patients undergoing brain surgery should be redefined. Future studies must establish the correlation between viscoelastic test results using fresh or citrate anticoagulated blood and clinical outcomes, such as bleeding, transfusion or reoperation for postoperative haematoma.
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Bonnard T, Law LS, Tennant Z, Hagemeyer CE. Development and validation of a high throughput whole blood thrombolysis plate assay. Sci Rep 2017; 7:2346. [PMID: 28539608 PMCID: PMC5443825 DOI: 10.1038/s41598-017-02498-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 04/11/2017] [Indexed: 12/26/2022] Open
Abstract
The objective of this work was to develop a high throughput assay for testing in vitro the thrombolytic activity using citrated whole blood samples, and to overcome the limitations of currently available techniques. We successfully developed a method that involves forming halo shaped, tissue factor induced, whole blood clots in 96 well plates, and then precisely measuring the thrombolysis process with a spectrophotometer plate reader. We here describe the implementation of this novel method, which we refer to as halo assay, and its validation with plasmin, urokinase and tissue plasminogen activator at different doses. The resulting data is a highly detailed thrombolysis profile, allowing comparison of different fibrinolytic agents. The time point analysis allows kinetic data to be collected and calculated to determine key parameters such as the activation time and the rate of fibrinolysis. We also assessed the capacity of the model to study the effect of clot maturation time on the fibrinolytic rate, an aspect of thrombosis rather unexplored with currently available methods, but of increasing importance in drug development. This novel thrombolysis assay could be an extremely useful research tool; to study the complex process of thrombolysis, and a valuable translational clinical tool; as a screening device to rapidly identify hypo- or hyper-fibrinolysis.
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Affiliation(s)
- T Bonnard
- NanoBiotechnology Laboratory, Australian Centre for Blood Diseases, Monash University, Melbourne, Australia.,VascularBiotechnology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - L S Law
- VascularBiotechnology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Z Tennant
- NanoBiotechnology Laboratory, Australian Centre for Blood Diseases, Monash University, Melbourne, Australia.,VascularBiotechnology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - C E Hagemeyer
- NanoBiotechnology Laboratory, Australian Centre for Blood Diseases, Monash University, Melbourne, Australia. .,VascularBiotechnology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia. .,RMIT University, Melbourne, Australia.
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Jansohn E, Bengzon J, Kander T, Schött U. A pilot study on the applicability of thromboelastometry in detecting brain tumour-induced hypercoagulation. Scandinavian Journal of Clinical and Laboratory Investigation 2017; 77:289-294. [DOI: 10.1080/00365513.2017.1306877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Schoergenhofer C, Buchtele N, Schwameis M, Bartko J, Jilma B, Jilma-Stohlawetz P. The use of frozen plasma samples in thromboelastometry. Clin Exp Med 2017; 17:489-497. [PMID: 28210886 PMCID: PMC5653723 DOI: 10.1007/s10238-017-0454-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/19/2017] [Indexed: 12/11/2022]
Abstract
Thromboelastometry is increasingly used in the clinical and scientific setting. The use of frozen plasma samples may be useful in overcoming certain limitations such as local and timely availability. Whole blood (WB) samples of 20 healthy volunteers were obtained, and plasma was generated. NATEM (n = 20), EXTEM (n = 20) and INTEM (n = 8) analyses were performed in WB, fresh plasma and frozen and thawed plasma. Dabigatran (500, 1000 ng/ml), rivaroxaban (100, 200 ng/ml) or alteplase (333 ng/ml) were added ex vivo to WB, and thromboelastometry was performed in WB and in frozen and thawed plasma samples. Clot formation time, mean clot firmness and the area under the curve were significantly altered in plasma compared to WB. In INTEM and EXTEM analysis, clotting time (CT) was comparable between WB (100%) and fresh (INTEM 114% and EXTEM 93%, ratio of the means) and frozen plasma samples (85 and 99%), whereas in NATEM analysis, the CT increased in fresh (193%) and frozen plasma samples (130%). Dabigatran dose-dependently increased the CT approximately 5- and 9-fold in WB and even more pronounced 10- and 26-fold in plasma. Accordingly, rivaroxaban dose-dependently increased the CT 2- and 2.7-fold in WB, and 3.5- and 4-fold in plasma samples. Hyperfibrinolysis was achieved by addition of alteplase in all WB samples and was reproducible in plasma samples. In conclusion, thromboelastometry, especially INTEM and EXTEM analyses, is possible using frozen and stored plasma samples with comparable results to the corresponding whole blood samples.
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Affiliation(s)
- Christian Schoergenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Nina Buchtele
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Schwameis
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Johann Bartko
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Stubblefield WB, Alves NJ, Rondina MT, Kline JA. Variable Resistance to Plasminogen Activator Initiated Fibrinolysis for Intermediate-Risk Pulmonary Embolism. PLoS One 2016; 11:e0148747. [PMID: 26866684 PMCID: PMC4751085 DOI: 10.1371/journal.pone.0148747] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 01/22/2016] [Indexed: 12/23/2022] Open
Abstract
Background We examine the clinical significance and biomarkers of tissue plasminogen activator (tPA)-catalyzed clot lysis time (CLT) in patients with intermediate-risk pulmonary embolism (PE). Methods Platelet-poor, citrated plasma was obtained from patients with PE. Healthy age- and sex-matched patients served as disease-negative controls. Fibrinogen, α2-antiplasmin, plasminogen, thrombin activatable fibrinolysis inhibitor (TAFI), plasminogen activator Inhibitor 1 (PAI-1), thrombin time and D-dimer were quantified. Clotting was induced using CaCl2, tissue factor, and phospholipid. Lysis was induced using 60 ng/mL tPA. Time to 50% clot lysis (CLT) was assessed by both thromboelastography (TEG) and turbidimetry (A405). Results Compared with disease-negative controls, patients with PE exhibited significantly longer mean CLT on TEG (+2,580 seconds, 95% CI 1,380 to 3,720 sec). Patients with PE and a short CLT who were treated with tenecteplase had increased risk of bleeding, whereas those with long CLT had significantly worse exercise tolerance and psychometric testing for quality of life at 3 months. A multivariate stepwise removal regression model selected PAI-1 and TAFI as predictive biomarkers of CLT. Conclusion The CLT from TEG predicted increased risk of bleeding and clinical failure with tenecteplase treatment for intermediate-risk PE. Plasmatic PAI-1 and TAFI were independent predictors of CLT.
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Affiliation(s)
| | - Nathan J. Alves
- Indiana University School of Medicine, Indianapolis, United States of America
| | - Matthew T. Rondina
- University of Utah School of Medicine, Salt Lake City, United States of America
| | - Jeffrey A. Kline
- Department of Emergency Medicine, and Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN, United States of America
- * E-mail:
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Hans GA, Besser MW. The place of viscoelastic testing in clinical practice. Br J Haematol 2016; 173:37-48. [DOI: 10.1111/bjh.13930] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Gregory A. Hans
- Department of Anaesthesia and Intensive Care Medicine; CHU of Liege; Liege Belgium
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Thomas O, Larsson A, Tynngård N, Schött U. Thromboelastometry versus free-oscillation rheometry and enoxaparin versus tinzaparin: an in-vitro study comparing two viscoelastic haemostatic tests' dose-responses to two low molecular weight heparins at the time of withdrawing epidural catheters from ten patients after major surgery. BMC Anesthesiol 2015; 15:170. [PMID: 26603039 PMCID: PMC4659161 DOI: 10.1186/s12871-015-0145-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 11/11/2015] [Indexed: 11/24/2022] Open
Abstract
Background Monitoring low molecular weight heparins (LMWH’s) in the perioperative period is prudent in patients at high risk of coagulative complications, especially when the patient has an epidural catheter requiring withdrawal, which is associated with the risk of spinal haematoma. The aim of this study was to evaluate the in vitro dose-responses of two different LMWH’s on two different viscoelastic haemostatic tests, using blood sampled from patients with normal routine coagulation parameters, on the day after major surgery when their epidural catheters were due to be withdrawn. Methods Enoxaparin or tinzaparin were added in vitro to blood from ten patients who had undergone oesophageal resection, to obtain plasma concentrations of approximately 0, 0.5, 1.0 and 1.5 IU/mL. Coagulation was monitored using thromboelastometry (ROTEM®) using the InTEM® activating reagent; and free oscillation rheometry (FOR: ReoRox®), activated using thromboplastin. Clot initiation was measured using ROTEM-CT, ReoRox-COT1 and ReoRox–COT2. Clot propagation was measured using ROTEM-CFT, ROTEM-Alpha Angle and ReoRox-Slope. Clot stability was measured using ROTEM-MCF and ReoRox-G’max, and clot lysis was measured using ROTEM-ML and ReoRox-ClotSR. Results Clot initiation time assessed by thromboelastometry and FOR was prolonged by increasing concentrations of both LMWH’s (P < 0.01). Equivalent doses of tinzaparin in international units (anti-FXa units) per millilitre prolonged clot initiation more than enoxaparin (P < 0.05). There was significant inter-individual variation – the ranges of CT and COT1 at LMWH-concentrations of 0 and 1.5 IU/mL overlapped. None of the tests reflecting clot formation rate or stability showed a dose–response to either LMWH but clot lysis showed a tentative negative dose–response to the LMWH’s. Conclusions Clot initiation time’s dose-dependent prolongation by LMWH’s in this study agrees with previous research, as does tinzaparin’s stronger anti-coagulative effect than enoxaparin at equivalent levels of anti-FXa activity. This casts doubt on the validity of using anti-FXa assays alone to guide dosage of LMWH’s. The significant inter-individual variation in dose–response suggests that the relationship between dose and effect in the postoperative period is complicated. While both ROTEM and FOR may have some role in postoperative monitoring, more research is needed before any conclusion can be made about their clinical usefulness. Electronic supplementary material The online version of this article (doi:10.1186/s12871-015-0145-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Owain Thomas
- Medical Faculty, University of Lund, Lund, Sweden. .,Department of Paediatric Anaesthesia and Intensive Care, SUS Lund University Hospital, Lund, Sweden.
| | - Anna Larsson
- Medical Faculty, University of Lund, Lund, Sweden
| | - Nahreen Tynngård
- Department of Clinical Immunology and Transfusion Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Clinical Chemistry, Department of Clinical Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ulf Schött
- Medical Faculty, University of Lund, Lund, Sweden.,Department of Anaesthesia and Intensive Care, SUS Lund University Hospital, Lund, Sweden
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Larsson A, Tynngård N, Kander T, Bonnevier J, Schött U. Comparison of point-of-care hemostatic assays, routine coagulation tests, and outcome scores in critically ill patients. J Crit Care 2015; 30:1032-8. [DOI: 10.1016/j.jcrc.2015.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/29/2015] [Accepted: 06/14/2015] [Indexed: 10/23/2022]
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Tynngård N, Lindahl TL, Ramström S. Assays of different aspects of haemostasis - what do they measure? Thromb J 2015; 13:8. [PMID: 25688179 PMCID: PMC4329663 DOI: 10.1186/s12959-015-0036-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/12/2015] [Indexed: 12/25/2022] Open
Abstract
Haemostasis is a complex process affected by many factors including both cellular and plasma components. It is a multistep process starting with platelet adhesion to damaged endothelium and ending in clot fibrinolysis. There are several methods available to study different aspects of haemostasis including adhesion, aggregation, coagulation and fibrinolysis. This review describes the different methods, what aspects of haemostasis they measure and their limitations. Methods discussed include methods to study adhesion (e.g. PFA-100, cone and platelet(let) analyzer and perfusion chambers) and aggregation (e.g. Multiplate, VerifyNow and Plateletworks). Furthermore the principles behind viscoelastic haemostatic assays are presented as well as methods that can analyse aspects of haemostasis in plasma or platelet-rich-plasma samples (thrombin generation, overall haemostasis potential and Thrombodynamics Analyzer).
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Affiliation(s)
- Nahreen Tynngård
- Department of Clinical Chemistry, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden ; Department of Clinical Immunology and Transfusion Medicine, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Tomas L Lindahl
- Department of Clinical Chemistry, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Sofia Ramström
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Roullet S, Freyburger G, Cruc M, Quinart A, Stecken L, Audy M, Chiche L, Sztark F. Management of bleeding and transfusion during liver transplantation before and after the introduction of a rotational thromboelastometry-based algorithm. Liver Transpl 2015; 21:169-79. [PMID: 25331016 DOI: 10.1002/lt.24030] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/30/2014] [Accepted: 10/12/2014] [Indexed: 02/07/2023]
Abstract
Orthotopic liver transplantation (OLT) remains a potentially hemorrhagic procedure. Rotational thromboelastometry (ROTEM) is a point-of-care device used to monitor coagulation during OLT. Whether it allows blood loss and transfusions to be reduced during OLT remains controversial. Excellent correlations and predictive values have been found between ROTEM parameters and fibrinogen. We hypothesized that the use of a ROTEM-based transfusion algorithm during OLT would lead to more fibrinogen transfusion and decreased bleeding and blood transfusion. Sixty adult patients were consecutively included in a prospective, without-versus-with study: 30 in the group without ROTEM results and 30 in the group with the ROTEM-based algorithm. A small and nonsignificant increase in median fibrinogen transfusions was found for the with group (6.0 g versus 4.5 g, P = 0.50). It was not associated with a decrease in blood transfusions or in the number of patients exposed to blood products.
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Affiliation(s)
- Stéphanie Roullet
- Anesthesia and Intensive care Department I, Bordeaux, France; Liver Transplant Unit, Bordeaux, France
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Solomon C, Schöchl H, Ranucci M, Schött U, Schlimp CJ. Comparison of fibrin-based clot elasticity parameters measured by free oscillation rheometry (ReoRox ®) versus thromboelastometry (ROTEM ®). Scandinavian Journal of Clinical and Laboratory Investigation 2015; 75:239-46. [PMID: 25598348 PMCID: PMC4389733 DOI: 10.3109/00365513.2014.993698] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background. Whole blood viscoelastic tests such as the fibrin-based thromboelastometry (ROTEM®) test FIBTEM are increasingly used in the perioperative setting to quickly identify deficits in fibrin quality, and to guide hemostatic therapy. The recently developed FibScreen2 test of the ReoRox® method, based on free oscillation rheometry, also provides an evaluation of fibrin clot quality. To date, little information is available on the performance of this test in hemodiluted blood, by comparison to FIBTEM. Methods. Whole blood samples from eight healthy volunteers were analyzed using FIBTEM and Fibscreen2. Native and diluted (to 33% and 50% using saline, gelatin or hydroxyethyl starch [HES]) samples were analyzed. Clot strength parameters, including FIBTEM maximum clot firmness (MCF), FIBTEM maximum clot elasticity (MCE) and Fibscreen2 maximum elasticity (G'max), were measured. Results. In repeatedly measured samples from two volunteers, FIBTEM MCF and Fibscreen2 G'max revealed a coefficient of variation (CV) of 5.3 vs. 16.3% and 5.6 vs. 31.7% for each volunteer, respectively. Hemodilution decreased clot strength. Both Fibscreen2 G'max and FIBTEM parameters decreased proportionally to the dilution ratio when saline was used. The observed reductions in FIBTEM and Fibscreen2 parameters were more severe in samples diluted with gelatin and HES, compared to saline. Finally, a regression analysis between FIBTEM MCE and Fibscreen2 G'max revealed a poor goodness of fit (r2 = 0.37, p < 0.0001). Conclusions. ReoRox® Fibscreen2 test has a high coefficient of variation, and its application in various hemodilution conditions showed limited comparability with the ROTEM® FIBTEM test.
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Affiliation(s)
- Cristina Solomon
- Department of Anesthesiology, Perioperative Medicine and General Intensive Care, Paracelsus Medical University , Salzburg , Austria
| | | | - Marco Ranucci
- Department of Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
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