What is the difference between classical thromboelastography and ROTEM® ?
The ROTEM® technology avoids several limitations of traditional instruments for thrombelastography,
especially the susceptibility to mechanical shocks and vibrations. Clot stability is detected simultaneously
on 4- channels with an innovative shock resistant opto-mechanical detection method. The operation is very
simple: intuitive touchscreen operated software.
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Can ROTEM® data be exported?
ROTEM® comes with a powerful intuitive software package and a sophisticated data handling system.
The database stores all results, including the reaction curves. Data can be printed with a standard printer,
transmitted to the LIS or can be easily exported into MS Excel® or other software for further processing.
Moreover, ongoing measurements can be displayed (via live transmission) on another computer, e.g. in
the OR.
What is the advantage of ROTEM® analysis over classical thromboelastography
or related methods?
Non-activated classical thromboelastography with native blood is very sensitive, but time consuming.
It requires very careful pre-analytical conditions in order to prevent artefacts and provides global information
on haemostasis without further differentiation. A superior diagnostic power is achieved with
ROTEM®analysis. Activated tests shorten the time for results and localise the defects. Deficiencies of
coagulation factors can be discriminated from effects of anticoagulants, hyperfibrinolysis, fibrin
polymerisation disorders, severe platelet function defects etc. Sample handling is relatively uncritical
and reliable data is also obtained during or after surgery. And handling is very easy.
What is the economical justification for introducing new tests?
Peri- or postoperative bleeding may lead to severe complications and very high expenses for blood
products, factor concentrates or other treatment. It prolongs the time in the ICU and in the hospital in
general. A specific, evidence based therapy instead of prophylactic use of blood products requires a
correct diagnosis:
"Use of TEM monitoring before reexploration has decreased the cost and potential risk for patients
undergoing CABG surgery." Changes in transfusion therapy and reexploration rate after institution of a
blood management program in cardiac surgical patients.
Spiess BD et al., J Cardiothorac Vasc. Anesth. 1995 168-73
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ROTEM® is very cost efficient when compared to other whole blood systems.
What can be potentially saved by ROTEM® analysis?
- Factor concentrates, fresh frozen plasma, cryoprecipitate, platelet concentrates
- Antifibrinolytic drugs, other drugs
- Surgery time and patient time in the ICU
- Total time in the hospital and for recovery
Is a POC application of ROTEM® efficient, or should the laboratory perform
the assays?
This depends strongly on the organisation of the individual hospital. If the turnaround time is > 30 min,
POC testing may be a clear advantage. Results should be available quickly in order to support
therapeutic decisions.
Provided that a sample arrives in the lab within a few minutes and immediate handling is possible, the
lab may be the right place. The ongoing measurements can be displayed through live transmission on a
computer in the OR.
Which type of sample should be preferably used?
Preferably citrated whole blood, the same sample which is used for coagulation tests. Normal blood
samples collected in sodium citrate are stable for hours. Non anticoagulated blood may theoretically
be superior but in practice this sample is difficult to standardise and the quality of the results are storage
time dependent. Clinical samples, especially during surgery or from patients with DIC, may be less stable
and should be analysed quickly. Other samples for research can be plasma or even clottable plasma
fractions such as fibrinogen solutions (e.g. fibrin sealants), when the appropriate activator is added.
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FAQ