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Rotem Rehberliğinde Kanama Yönetimi

Year 2025, Volume: 4 Issue: 1, 44 - 50

Mehmet Akif Yılmaz , Habip Burak Özgödek , Nuray Uzun , Muhammed Enes Aydın , Erkan Cem Çelik

Abstract

Rotasyonel tromboelastometri (ROTEM), çeşitli klinik ortamlarda tam kanın viskoelastik profillerinin değerlendirilmesini sağlar. ROTEM kılavuzluğunda kanama yönetimi, hasta kan yönetiminin (HKY) temel bir parçası haline gelmiştir. ROTEM kılavuzluğunda HKY; kanamayı, transfüzyon gereksinimlerini, komplikasyon oranlarını ve sağlık bakım maliyetlerini azaltmada etkili olduğu gösterilmiştir. Birkaç randomize kontrollü çalışma ve meta-analiz, kanayan hastalarda ROTEM rehberliğinin; peroperatif morbidite ve mortaliteyi iyileştirdiğine dair kanıt sağlamıştır. Sık görülen kanama senaryoları üzerinden ROTEM sonuçları ve bu sonuçlara göre yapılacak hemostatik müdahaleler tartışılmıştır.

Keywords

Viskoelastik testler rotasyonel tromboelastometri post-partum kanama post-travmatik kanama kardiyovasküler cerrahi hastasında kanama transfüzyon yönetimi

References

  • 1. Zacharowski K, Spahn DR. Patient blood management equals patient safety. Best Pract Res Clin Anaesthesiol. 2016;30(2):159-169. doi:10.1016/j.bpa.2016.04.008
  • 2. Inaba K, Branco BC, Rhee P, et al. Impact of plasma transfusion in trauma patients who do not require massive transfusion. J Am Coll Surg. 2010;210(6):957-965. doi:10.1016/j.jamcollsurg.2010.01.031
  • 3. Desborough M, Sandu R, Brunskill SJ, et al. Fresh frozen plasma for cardiovascular surgery. Cochrane Database Syst Rev. 2015;2015(7):Cd007614. doi:10.1002/14651858.CD007614.pub2
  • 4. Warner MA, Chandran A, Jenkins G, Kor DJ. Prophylactic Plasma Transfusion Is Not Associated With Decreased Red Blood Cell Requirements in Critically Ill Patients. Anesth Analg. 2017;124(5):1636-1643. doi:10.1213/ane.0000000000001730
  • 5. Warner MA, Jia Q, Clifford L, et al. Preoperative platelet transfusions and perioperative red blood cell requirements in patients with thrombocytopenia undergoing noncardiac surgery. Transfusion. 2016;56(3):682-690. doi:10.1111/trf.13414
  • 6. Khan S, Brohi K, Chana M, et al. Hemostatic resuscitation is neither hemostatic nor resuscitative in trauma hemorrhage. J Trauma Acute Care Surg. 2014;76(3):561-567; discussion 567-568. doi:10.1097/ta.0000000000000146
  • 7. Khan S, Davenport R, Raza I, et al. Damage control resuscitation using blood component therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage. Intensive Care Med. 2015;41(2):239-247. doi:10.1007/s00134-014-3584-1
  • 8. Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313(5):471-482. doi:10.1001/jama.2015.12
  • 9. Winearls J, Reade M, Miles H, et al. Targeted Coagulation Management in Severe Trauma: The Controversies and the Evidence. Anesth Analg. 2016;123(4):910-924. doi:10.1213/ane.0000000000001516
  • 10. Toulon P, Ozier Y, Ankri A, Fléron MH, Leroux G, Samama CM. Point-of-care versus central laboratory coagulation testing during haemorrhagic surgery. A multicenter study. Thromb Haemost. 2009;101(2):394-401.
  • 11. Davenport R, Manson J, De'Ath H, et al. Functional definition and characterization of acute traumatic coagulopathy. Crit Care Med. 2011;39(12):2652-2658. doi:10.1097/CCM.0b013e3182281af5
  • 12. Olde Engberink RH, Kuiper GJ, Wetzels RJ, et al. Rapid and correct prediction of thrombocytopenia and hypofibrinogenemia with rotational thromboelastometry in cardiac surgery. J Cardiothorac Vasc Anesth. 2014;28(2):210-216. doi:10.1053/j.jvca.2013.12.004
  • 13. Görlinger K, Pérez-Ferrer A, Dirkmann D, et al. The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management. Korean J Anesthesiol. 2019;72(4):297-322. doi:10.4097/kja.19169
  • 14. Schöchl H, Cotton B, Inaba K, et al. FIBTEM provides early prediction of massive transfusion in trauma. Crit Care. 2011;15(6):R265. doi:10.1186/cc10539
  • 15. Hagemo JS, Christiaans SC, Stanworth SJ, et al. Detection of acute traumatic coagulopathy and massive transfusion requirements by means of rotational thromboelastometry: an international prospective validation study. Crit Care. 2015;19(1):97. doi:10.1186/s13054-015-0823-y
  • 16. Dötsch TM, Dirkmann D, Bezinover D, et al. Assessment of standard laboratory tests and rotational thromboelastometry for the prediction of postoperative bleeding in liver transplantation. Br J Anaesth. 2017;119(3):402-410. doi:10.1093/bja/aex122
  • 17. Dias JD, Levy JH, Tanaka KA, Zacharowski K, Hartmann J. Viscoelastic haemostatic assays to guide therapy in elective surgery: an updated systematic review and meta-analysis. Anaesthesia. 2025;80(1):95-103. doi:10.1111/anae.16463
  • 18. Weber CF, Görlinger K, Meininger D, et al. Point-of-care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology. 2012;117(3):531-547. doi:10.1097/ALN.0b013e318264c644
  • 19. Deppe AC, Weber C, Zimmermann J, et al. Point-of-care thromboelastography/thromboelastometry-based coagulation management in cardiac surgery: a meta-analysis of 8332 patients. J Surg Res. 2016;203(2):424-433. doi:10.1016/j.jss.2016.03.008
  • 20. Wikkelsø A, Wetterslev J, Møller AM, Afshari A. Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding. Cochrane Database Syst Rev. 2016;2016(8):Cd007871. doi:10.1002/14651858.CD007871.pub3
  • 21. Shen J, Sampietro S, Wu J, et al. Coordination of platelet agonist signaling during the hemostatic response in vivo. Blood Adv. 2017;1(27):2767-2775. doi:10.1182/bloodadvances.2017009498
  • 22. Guyette FX, Brown JB, Zenati MS, et al. Tranexamic Acid During Prehospital Transport in Patients at Risk for Hemorrhage After Injury: A Double-blind, Placebo-Controlled, Randomized Clinical Trial. JAMA Surg. 2020;156(1):11-20. doi:10.1001/jamasurg.2020.4350
  • 23. Gruen RL, Mitra B, Bernard SA, et al. Prehospital Tranexamic Acid for Severe Trauma. N Engl J Med. 2023;389(2):127-136. doi:10.1056/NEJMoa2215457
  • 24. Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376(9734):23-32. doi:10.1016/s0140-6736(10)60835-5
  • 25. Drotarova M, Zolkova J, Belakova KM, et al. Basic Principles of Rotational Thromboelastometry (ROTEM(®)) and the Role of ROTEM-Guided Fibrinogen Replacement Therapy in the Management of Coagulopathies. Diagnostics (Basel). 2023;13(20)doi:10.3390/diagnostics13203219
  • 26. Brill JB, Brenner M, Duchesne J, et al. The Role of TEG and ROTEM in Damage Control Resuscitation. Shock. 2021;56(1s):52-61. doi:10.1097/shk.0000000000001686
  • 27. Na HS, Shin HJ, Do SH. FIBTEM provides prediction of massive bleeding in total hip replacement arthroplasty. Blood Coagul Fibrinolysis. 2016;27(3):340-346. doi:10.1097/mbc.0000000000000428
  • 28. Drotarova M, Zolkova J, Belakova KM, et al. Basic Principles of Rotational Thromboelastometry (ROTEM®) and the Role of ROTEM—Guided Fibrinogen Replacement Therapy in the Management of Coagulopathies. Diagnostics. 2023;13(20):3219.
  • 29. Lang T, Bauters A, Braun SL, et al. Multi-centre investigation on reference ranges for ROTEM thromboelastometry. Blood Coagul Fibrinolysis. 2005;16(4):301-310. doi:10.1097/01.mbc.0000169225.31173.19
  • 30. Schenk B, Görlinger K, Treml B, et al. A comparison of the new ROTEM(®) sigma with its predecessor, the ROTEMdelta. Anaesthesia. 2019;74(3):348-356. doi:10.1111/anae.14542
  • 31. Sokou R, Foudoulaki-Paparizos L, Lytras T, et al. Reference ranges of thromboelastometry in healthy full-term and pre-term neonates. Clin Chem Lab Med. 2017;55(10):1592-1597. doi:10.1515/cclm-2016-0931
  • 32. Oswald E, Stalzer B, Heitz E, et al. Thromboelastometry (ROTEM) in children: age-related reference ranges and correlations with standard coagulation tests. Br J Anaesth. Dec 2010;105(6):827-835. doi:10.1093/bja/aeq258
  • 33. de Lange NM, van Rheenen-Flach LE, Lancé MD, et al. Peri-partum reference ranges for ROTEM(R) thromboelastometry. Br J Anaesth. 2014;112(5):852-859. doi:10.1093/bja/aet480
  • 34. Oudghiri M, Keita H, Kouamou E, et al. Reference values for rotation thromboelastometry (ROTEM®) parameters following non-haemorrhagic deliveries. Correlations with standard haemostasis parameters. Thromb Haemost. 2011;106(1):176-178. doi:10.1160/th11-02-0058
  • 35. Weyand AC, Flood VH. Von Willebrand Disease: Current Status of Diagnosis and Management. Hematol Oncol Clin North Am. 2021;35(6):1085-1101. doi:10.1016/j.hoc.2021.07.004

Rotem Guided Bleeding Management

Year 2025, Volume: 4 Issue: 1, 44 - 50

Mehmet Akif Yılmaz , Habip Burak Özgödek , Nuray Uzun , Muhammed Enes Aydın , Erkan Cem Çelik

Abstract

Rotational thromboelastometry (ROTEM) enables the assessment of viscoelastic profiles of whole blood in a variety of clinical settings. ROTEM-guided bleeding management has become an essential part of patient blood management (PBM). ROTEM-guided PBM (Patient Blood Management) has been shown to be effective in reducing bleeding, transfusion requirements, complication rates, and healthcare costs. Several randomized controlled trials and meta-analyses have provided evidence that ROTEM guidance improves perioperative morbidity and mortality in bleeding patients. ROTEM results and the corresponding hemostatic interventions for common bleeding scenarios are discussed.

Keywords

Viscoelastic Tests Rotational thromboelastometry Post-partum bleeding Post-traumatic bleeding Bleeding in cardiovascular surgery patients Transfusion management

References

  • 1. Zacharowski K, Spahn DR. Patient blood management equals patient safety. Best Pract Res Clin Anaesthesiol. 2016;30(2):159-169. doi:10.1016/j.bpa.2016.04.008
  • 2. Inaba K, Branco BC, Rhee P, et al. Impact of plasma transfusion in trauma patients who do not require massive transfusion. J Am Coll Surg. 2010;210(6):957-965. doi:10.1016/j.jamcollsurg.2010.01.031
  • 3. Desborough M, Sandu R, Brunskill SJ, et al. Fresh frozen plasma for cardiovascular surgery. Cochrane Database Syst Rev. 2015;2015(7):Cd007614. doi:10.1002/14651858.CD007614.pub2
  • 4. Warner MA, Chandran A, Jenkins G, Kor DJ. Prophylactic Plasma Transfusion Is Not Associated With Decreased Red Blood Cell Requirements in Critically Ill Patients. Anesth Analg. 2017;124(5):1636-1643. doi:10.1213/ane.0000000000001730
  • 5. Warner MA, Jia Q, Clifford L, et al. Preoperative platelet transfusions and perioperative red blood cell requirements in patients with thrombocytopenia undergoing noncardiac surgery. Transfusion. 2016;56(3):682-690. doi:10.1111/trf.13414
  • 6. Khan S, Brohi K, Chana M, et al. Hemostatic resuscitation is neither hemostatic nor resuscitative in trauma hemorrhage. J Trauma Acute Care Surg. 2014;76(3):561-567; discussion 567-568. doi:10.1097/ta.0000000000000146
  • 7. Khan S, Davenport R, Raza I, et al. Damage control resuscitation using blood component therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage. Intensive Care Med. 2015;41(2):239-247. doi:10.1007/s00134-014-3584-1
  • 8. Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313(5):471-482. doi:10.1001/jama.2015.12
  • 9. Winearls J, Reade M, Miles H, et al. Targeted Coagulation Management in Severe Trauma: The Controversies and the Evidence. Anesth Analg. 2016;123(4):910-924. doi:10.1213/ane.0000000000001516
  • 10. Toulon P, Ozier Y, Ankri A, Fléron MH, Leroux G, Samama CM. Point-of-care versus central laboratory coagulation testing during haemorrhagic surgery. A multicenter study. Thromb Haemost. 2009;101(2):394-401.
  • 11. Davenport R, Manson J, De'Ath H, et al. Functional definition and characterization of acute traumatic coagulopathy. Crit Care Med. 2011;39(12):2652-2658. doi:10.1097/CCM.0b013e3182281af5
  • 12. Olde Engberink RH, Kuiper GJ, Wetzels RJ, et al. Rapid and correct prediction of thrombocytopenia and hypofibrinogenemia with rotational thromboelastometry in cardiac surgery. J Cardiothorac Vasc Anesth. 2014;28(2):210-216. doi:10.1053/j.jvca.2013.12.004
  • 13. Görlinger K, Pérez-Ferrer A, Dirkmann D, et al. The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management. Korean J Anesthesiol. 2019;72(4):297-322. doi:10.4097/kja.19169
  • 14. Schöchl H, Cotton B, Inaba K, et al. FIBTEM provides early prediction of massive transfusion in trauma. Crit Care. 2011;15(6):R265. doi:10.1186/cc10539
  • 15. Hagemo JS, Christiaans SC, Stanworth SJ, et al. Detection of acute traumatic coagulopathy and massive transfusion requirements by means of rotational thromboelastometry: an international prospective validation study. Crit Care. 2015;19(1):97. doi:10.1186/s13054-015-0823-y
  • 16. Dötsch TM, Dirkmann D, Bezinover D, et al. Assessment of standard laboratory tests and rotational thromboelastometry for the prediction of postoperative bleeding in liver transplantation. Br J Anaesth. 2017;119(3):402-410. doi:10.1093/bja/aex122
  • 17. Dias JD, Levy JH, Tanaka KA, Zacharowski K, Hartmann J. Viscoelastic haemostatic assays to guide therapy in elective surgery: an updated systematic review and meta-analysis. Anaesthesia. 2025;80(1):95-103. doi:10.1111/anae.16463
  • 18. Weber CF, Görlinger K, Meininger D, et al. Point-of-care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology. 2012;117(3):531-547. doi:10.1097/ALN.0b013e318264c644
  • 19. Deppe AC, Weber C, Zimmermann J, et al. Point-of-care thromboelastography/thromboelastometry-based coagulation management in cardiac surgery: a meta-analysis of 8332 patients. J Surg Res. 2016;203(2):424-433. doi:10.1016/j.jss.2016.03.008
  • 20. Wikkelsø A, Wetterslev J, Møller AM, Afshari A. Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding. Cochrane Database Syst Rev. 2016;2016(8):Cd007871. doi:10.1002/14651858.CD007871.pub3
  • 21. Shen J, Sampietro S, Wu J, et al. Coordination of platelet agonist signaling during the hemostatic response in vivo. Blood Adv. 2017;1(27):2767-2775. doi:10.1182/bloodadvances.2017009498
  • 22. Guyette FX, Brown JB, Zenati MS, et al. Tranexamic Acid During Prehospital Transport in Patients at Risk for Hemorrhage After Injury: A Double-blind, Placebo-Controlled, Randomized Clinical Trial. JAMA Surg. 2020;156(1):11-20. doi:10.1001/jamasurg.2020.4350
  • 23. Gruen RL, Mitra B, Bernard SA, et al. Prehospital Tranexamic Acid for Severe Trauma. N Engl J Med. 2023;389(2):127-136. doi:10.1056/NEJMoa2215457
  • 24. Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376(9734):23-32. doi:10.1016/s0140-6736(10)60835-5
  • 25. Drotarova M, Zolkova J, Belakova KM, et al. Basic Principles of Rotational Thromboelastometry (ROTEM(®)) and the Role of ROTEM-Guided Fibrinogen Replacement Therapy in the Management of Coagulopathies. Diagnostics (Basel). 2023;13(20)doi:10.3390/diagnostics13203219
  • 26. Brill JB, Brenner M, Duchesne J, et al. The Role of TEG and ROTEM in Damage Control Resuscitation. Shock. 2021;56(1s):52-61. doi:10.1097/shk.0000000000001686
  • 27. Na HS, Shin HJ, Do SH. FIBTEM provides prediction of massive bleeding in total hip replacement arthroplasty. Blood Coagul Fibrinolysis. 2016;27(3):340-346. doi:10.1097/mbc.0000000000000428
  • 28. Drotarova M, Zolkova J, Belakova KM, et al. Basic Principles of Rotational Thromboelastometry (ROTEM®) and the Role of ROTEM—Guided Fibrinogen Replacement Therapy in the Management of Coagulopathies. Diagnostics. 2023;13(20):3219.
  • 29. Lang T, Bauters A, Braun SL, et al. Multi-centre investigation on reference ranges for ROTEM thromboelastometry. Blood Coagul Fibrinolysis. 2005;16(4):301-310. doi:10.1097/01.mbc.0000169225.31173.19
  • 30. Schenk B, Görlinger K, Treml B, et al. A comparison of the new ROTEM(®) sigma with its predecessor, the ROTEMdelta. Anaesthesia. 2019;74(3):348-356. doi:10.1111/anae.14542
  • 31. Sokou R, Foudoulaki-Paparizos L, Lytras T, et al. Reference ranges of thromboelastometry in healthy full-term and pre-term neonates. Clin Chem Lab Med. 2017;55(10):1592-1597. doi:10.1515/cclm-2016-0931
  • 32. Oswald E, Stalzer B, Heitz E, et al. Thromboelastometry (ROTEM) in children: age-related reference ranges and correlations with standard coagulation tests. Br J Anaesth. Dec 2010;105(6):827-835. doi:10.1093/bja/aeq258
  • 33. de Lange NM, van Rheenen-Flach LE, Lancé MD, et al. Peri-partum reference ranges for ROTEM(R) thromboelastometry. Br J Anaesth. 2014;112(5):852-859. doi:10.1093/bja/aet480
  • 34. Oudghiri M, Keita H, Kouamou E, et al. Reference values for rotation thromboelastometry (ROTEM®) parameters following non-haemorrhagic deliveries. Correlations with standard haemostasis parameters. Thromb Haemost. 2011;106(1):176-178. doi:10.1160/th11-02-0058
  • 35. Weyand AC, Flood VH. Von Willebrand Disease: Current Status of Diagnosis and Management. Hematol Oncol Clin North Am. 2021;35(6):1085-1101. doi:10.1016/j.hoc.2021.07.004
There are 35 citations in total.

Details

Primary Language English
Subjects General Surgery
Journal Section Review
Authors

Mehmet Akif Yılmaz 0000-0002-9204-4611

Habip Burak Özgödek 0000-0003-3042-9505

Nuray Uzun 0009-0001-1382-5533

Muhammed Enes Aydın 0000-0001-8491-6566

Erkan Cem Çelik 0000-0002-7773-9562

Early Pub Date April 8, 2025
Publication Date
Submission Date November 15, 2024
Acceptance Date February 8, 2025
Published in Issue Year 2025 Volume: 4 Issue: 1

Cite

AMA Yılmaz MA, Özgödek HB, Uzun N, Aydın ME, Çelik EC. Rotem Guided Bleeding Management. Trends in Surgical Sciences. April 2025;4(1):44-50.
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