title: Comparison between thrombelastography and thromboelastometry in hyperfibrinolysis detection during adult liver transplantation.
abstract: BACKGROUND
  Hyperfibrinolysis is one of the main causes of non-surgical bleeding during liver transplantation (LT). Viscoelastic haemostatic assays, including thromboelastometry (ROTEM(®)) and thrombelastography (TEG(®)), can detect hyperfibrinolysis at the bedside. No study has yet demonstrated which device or assay is more suitable for detecting hyperfibrinolysis.
  
  
  METHODS
  This prospective observational study compared ROTEM(®) and TEG(®) in isolated adult LT. ROTEM(®) (EXTEM(®) [tissue factor activation], FIBTEM(®) [tissue factor activation with platelet inhibition], and APTEM(®) [tissue factor activation with tranexamic acid/aprotinin]) and TEG(®) (kaolin-TEG(®)) were simultaneously performed using arterial blood samples at eight time-points during LT: induction of general anaesthesia, 60 min after skin incision, 10 and 45 min after portal vein clamp, 15 min before graft reperfusion, and five, 30, and 90 min after graft reperfusion. Hyperfibrinolysis was identified per the manufacturers' definitions (maximum lysis >15% in ROTEM(®) or Lysis30>8% in TEG(®)) and confirmed with APTEM(®); incidence was compared between assays McNemar's test.
  
  
  RESULTS
  Among 296 possible measurement points from 376 consecutive LT recipients, 250 underwent final analysis: 46 measurement points were excluded because of missing assays or flat line. Hyperfibrinolysis was confirmed at 89 (36%) of 250 measurement points: FIBTEM(®), EXTEM(®), and kaolin-TEG(®) detected 84 (94%), 41 (46%), and 21 (24%) hyperfibrinolysis, respectively. These hyperfibrinolysis detection rates significantly differed from each other (P<0.001).
  
  
  CONCLUSIONS
  Tissue factor-triggered ROTEM(®) tests were more sensitive than contact-activated k-TEG(®) in identifying hyperfibrinolysis in LT patients. Inhibition of platelet-fibrin interaction in FIBTEM(®) enhanced sensitivity to hyperfibrinolysis detection compared with EXTEM(®).
authors.affiliation: Department of Anesthesiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
authors.forename: E
authors.initials: E
authors.lastname: Abuelkasem
authors.affiliation: Department of Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: S
authors.initials: S
authors.lastname: Lu
authors.affiliation: Department of Anesthesiology, University of Maryland Medical Center, Baltimore, MD 21201-1559, USA.
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Department of Anesthesiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
authors.forename: R
authors.initials: R
authors.lastname: Planinsic
authors.affiliation: Department of Anesthesiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA The Clinical and Translational Science Institute, University of Pittsburgh, Atwood & Sennott Streets, Pittsburgh, PA 15260, USA sakait@upmc.edu.
authors.forename: T
authors.initials: T
authors.lastname: Sakai
mesh_terms: D000768:Anesthesia, General; D000933:Antifibrinolytic Agents / Q000494:pharmacology; D001778:Blood Coagulation Disorders / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D001780:Blood Coagulation Tests; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D007431:Intraoperative Complications / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013916:Thrombelastography / Q000379:methods*; D013925:Thromboplastin / Q000494:pharmacology; D014148:Tranexamic Acid / Q000494:pharmacology
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D013925:Thromboplastin
keywords: clinical laboratory techniques; fibrinolysis; liver transplantation; thrombelastography