title: Viscoelastic hemostatic fibrinogen assays detect fibrinolysis early.
abstract: OBJECTIVE
  Viscoelastic hemostatic assays are emerging as the standard-of-care in the early detection of post-injury coagulopathy. TEG and ROTEM are most commonly used. Although similar in technique, each uses different reagents, which may affect their sensitivity to detect fibrinolysis. Therefore, the purpose of this study is to determine the ability of each device to detect fibrinolysis.
  
  
  METHODS
  TEG (Rapid, Kaolin, Functional Fibrinogen) and ROTEM (EXTEM, INTEM, FIBTEM) were run simultaneously on normal blood as well as blood containing tPA from healthy volunteers (n = 10). A two-tailed, paired t-test and ANOVA were used to determine the significance between parameters obtained from normal blood and blood with tPA, and individual TEG and ROTEM assays, respectively.
  
  
  RESULTS
  TEG detected significant changes in clot strength and 30-min lysis after the addition of tPA (p < 0.0001). All ROTEM assays detected changes in the 30-min lysis (p < 0.0001), but only INTEM detected changes in clot strength (p < 0.05). Kaolin and Rapid TEG assays detected greater changes in clot strength and lysis, but INTEM and EXTEM had decreased lysis onset times compared to TEG (p < 0.001). Functional Fibrinogen and FIBTEM assays detected lysis sooner than other TEG/ROTEM assays, and were comparable.
  
  
  CONCLUSIONS
  TEG assays detect greater changes in clot strength compared to ROTEM. Despite this, Functional Fibrinogen and FIBTEM assays detect fibrinolysis sooner than their corresponding intrinsic and extrinsic assays. Therefore, fibrinogen assays should be employed in actively bleeding trauma patients in order to provide timely antifibrinolytic therapy.
authors.affiliation: Department of Surgery, University of Colorado Denver, Aurora, CO, USA, jeffrey.harr@ucdenver.edu.
authors.forename: J N
authors.initials: JN
authors.lastname: Harr
authors.forename: E E
authors.initials: EE
authors.lastname: Moore
authors.forename: T L
authors.initials: TL
authors.lastname: Chin
authors.forename: M P
authors.initials: MP
authors.lastname: Chapman
authors.forename: A
authors.initials: A
authors.lastname: Ghasabyan
authors.forename: J R
authors.initials: JR
authors.lastname: Stringham
authors.forename: A
authors.initials: A
authors.lastname: Banerjee
authors.forename: C C
authors.initials: CC
authors.lastname: Silliman
mesh_terms: D001778:Blood Coagulation Disorders / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D001794:Blood Pressure; D003422:Critical Care; D042241:Early Diagnosis; D005342:Fibrinolysis; D006801:Humans; D019095:Point-of-Care Systems; D012680:Sensitivity and Specificity; D012771:Shock, Hemorrhagic / Q000097:blood / Q000517:prevention & control*; D013916:Thrombelastography / Q000295:instrumentation; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications* / Q000503:physiopathology