Journal article
Position of the French Working Group on Perioperative Haemostasis (GIHP) on viscoelastic tests: What role for which indication in bleeding situations?
- Roullet S Inserm U 12-11, service anesthésie-réanimation 1, université de Bordeaux, CHU de Bordeaux, 33000 Bordeaux, France. Electronic address: stephanie.roullet@chu-bordeaux.fr.
- de Maistre E Unité d'hémostase, centre hospitalier universitaire, 21079 Dijon, France.
- Ickx B Université Libre de Bruxelles, Erasme University Hospital, Department of Anesthesiology, Brussels, Belgium.
- Blais N Hématologie et oncologie médicale, CHUM, Montréal, Canada.
- Susen S Institut d'hématologie et transfusion, CHRU de Lille, 59037 Lille, France.
- Faraoni D Department of Anaesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
- Garrigue D Pôle d'anesthésie-réanimation, CHRU de Lille, 59037 Lille, France.
- Bonhomme F Service d'anesthésiologie, hôpital universitaire de Genève, Geneva, Switzerland.
- Godier A Service d'anesthésie-réanimation, Fondation Rothschild, 75019 Paris, France.
- Lasne D Laboratoire d'hématologie, hôpital Necker, 75015 Paris, France.
- 2018-01-23
Published in:
- Anaesthesia, critical care & pain medicine. - 2019
Cardiac surgery
Liver transplantation
Severe trauma
Thromboelastography
Thromboelastometry
Viscoelastic tests
Adult
Algorithms
Blood Coagulation
Cardiac Surgical Procedures
Child
Emergencies
Female
France
Hemorrhage
Hemostasis, Surgical
Humans
Liver Transplantation
Male
Postpartum Hemorrhage
Societies, Medical
Thrombelastography
Wounds and Injuries
English
PURPOSE
Viscoelastic tests (VETs), thromboelastography (TEG®) and thromboelastometry (ROTEM®) are global tests of coagulation performed on whole blood. They evaluate the mechanical strength of a clot as it builds and develops after coagulation itself. The time required to obtain haemostasis results remains a major problem for clinicians dealing with bleeding, although some teams have developed a rapid laboratory response strategy. Indeed, the value of rapid point-of-care diagnostic devices such as VETs has increased over the years. However, VETs are not standardised and there are few recommendations from the learned societies regarding their use. In 2014, the recommendations of the International Society of Thrombosis and Haemostasis (ISTH) only concerned haemophilia. The French Working Group on Perioperative haemostasis (GIHP) therefore proposes to summarise knowledge on the clinical use of these techniques in the setting of emergency and perioperative medicine.
METHODS
A review of the literature.
PRINCIPAL FINDINGS
The role of the VETs seems established in the management of severe trauma and in cardiac surgery, both adult and paediatric. In other situations, their role remains to be defined: hepatic transplantation, postpartum haemorrhage, and non-cardiac surgery. They must be part of the global management of haemostasis based on algorithms defined in each centre and for each population of patients. Their position at the bedside or in the laboratory is a matter of discussion between clinicians and biologists.
CONCLUSION
VETs must be included in algorithms. In consultation with the biology laboratory, these devices should be situated according to the way each centre functions.
Viscoelastic tests (VETs), thromboelastography (TEG®) and thromboelastometry (ROTEM®) are global tests of coagulation performed on whole blood. They evaluate the mechanical strength of a clot as it builds and develops after coagulation itself. The time required to obtain haemostasis results remains a major problem for clinicians dealing with bleeding, although some teams have developed a rapid laboratory response strategy. Indeed, the value of rapid point-of-care diagnostic devices such as VETs has increased over the years. However, VETs are not standardised and there are few recommendations from the learned societies regarding their use. In 2014, the recommendations of the International Society of Thrombosis and Haemostasis (ISTH) only concerned haemophilia. The French Working Group on Perioperative haemostasis (GIHP) therefore proposes to summarise knowledge on the clinical use of these techniques in the setting of emergency and perioperative medicine.
METHODS
A review of the literature.
PRINCIPAL FINDINGS
The role of the VETs seems established in the management of severe trauma and in cardiac surgery, both adult and paediatric. In other situations, their role remains to be defined: hepatic transplantation, postpartum haemorrhage, and non-cardiac surgery. They must be part of the global management of haemostasis based on algorithms defined in each centre and for each population of patients. Their position at the bedside or in the laboratory is a matter of discussion between clinicians and biologists.
CONCLUSION
VETs must be included in algorithms. In consultation with the biology laboratory, these devices should be situated according to the way each centre functions.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1016/j.accpm.2017.12.014
- PMID 29355793
- Persistent URL
- https://sonar.ch/global/documents/34228
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