docViszkoelasztikus tesztek (TEG®, ROTEM®)
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Viszkoelasztikus tesztek (TEG®, ROTEM®)
Point of care diagnosztika - a „hozzáadott érték” - Dr. Tánczos Krisztián Aneszteziológiai és Intenzív Terápiás Intézet Súlyos vérzéses állapotok patofiziológiája, diagnosztikája és korszerű kezelése Továbbképző tanfolyam 2014 Basics of coagulation… Zhang et al J Neurotrauma 2012; 29:2597–2605 fibrinolysis Primary hemostasis Clot formation Trombingeneration Basics of coagulation… Dr. Dietmar Fries: Basics of coagulation 2013; CSL Behring Symposium Standard plasmatic coagulation tests PT / INR aPTT 5% Mann KG et al Circulation 2011; 124:225-235 static and late tests Tanaka KA et al Anesth Analg 2009; 108:1433-1446 Toulon P et al Thromb Haemost 2009;101:394-401 Standard plasmatic coagulation tests PT / INR aPTT Anticoagulation therapy Mann KG et al Circulation 2011; 124:225-235 5% Davenport R et al Crit Care Med 2011; 39:2652-2658,2011 Maegele M Transfusion 2013;53:28S-37S. Hipokoaguláció Antikoaguláció Hiperfibrinolízis Optimal coagulation test: Fast – Whole blood - Dynamic In severe hemostatic disorders: Standard coagulation test Viscoelastic tests (TEG®, ROTEM®) Platelet function tests (Multiplate®) Viscoelastic tests (TEG®, ROTEM®) Bolliger D et al Transfusion Medicine Reviews 2012; 26: 1-13 Fast – Whole Blood - Dynamic Platelet aggregometry TEG® Schöchl H et al J Trauma Acute Care Surg. 2013; 74 (6):1587-1598 R ROTEM® Schöchl H et al J Trauma Acute Care Surg. 2013; 74 (6):1587-1598 TEG® vs. ROTEM® Clot strength Stravicz RT et al Gastroent & Hepat 2012; 8: 513-520 Activators… Solomon C et al BJA 2012; 109 (6): 851–63 Kaolin-TEG INTEM Fibrinolysis Activators Solomon C et al BJA 2012; 109 (6): 851–63 Kaolin-TEG INTEM EXTEM Fibrinolysis Activators Solomon C et al BJA 2012; 109 (6): 851–63 Kaolin-TEG INTEM EXTEM Rapid TEG Fibrinolysis TEG® vs. ROTEM® Clot strength Stravicz RT et al Gastroent & Hepat 2012; 8: 513-520 Activators Solomon C et al BJA 2012; 109 (6): 851–63 Kaolin-TEG INTEM EXTEM Rapid TEG abciximab cytochalasin D Fibrinolysis FF test / FIBTEM TEG® vs. ROTEM® Clot strength Stravicz RT et al Gastroent & Hepat 2012; 8: 513-520 Activators Solomon C et al BJA 2012; 109 (6): 851–63 Kaolin-TEG INTEM EXTEM Rapid TEG abciximab cytochalasin D APTEM aprotinin Fibrinolysis FIBTEM Activators Solomon C et al BJA 2012; 109 (6): 851–63 TEG/ROTEM curves… Platelets… Life span: 5-10 days Platelet’s function Zhang et al J Neurotrauma 2012; 29:2597–2605 Platelet adhesion vWF Collagen Platelet activation ADP Platelet aggregation „Thrombocyta burst” TXA2 Thrombin Fibrin Fibrinogen Extrinsic pathway Intrinsic pathway Common pathway Aggregation (AU) Multiple Electrode Aggregometry (MEA) Multiplate® Area under the curve = AUC (AU x min) α Time (min) Activators… Platelet Adhesion (vWF, COLL) Platelet activation (ADP burst) Platelet aggregation „Thrombocyta burst” (Thrombin) Antiplatelet treatment Wohlauer et al. J Am Coll Surg. 2012; 214(5): 739–746 What we know so far about… Fast and dynamic use the whole blood – more details of the hemostasis May be preferred in complex coagulopathy (massive bleeding, extracorp. circulation, organ transplantation, politrauma) - no information about the role of endothelium and blood flows - insensitive to platelets – endothel interactions (von-Willebrand disease, antiplatlets drugs) - Quality controll Take Home Message Complex coagulopathy and Time Viscoelastic test (CT, CFT, α, MCF, ML) Conventional test (I., II., III.,……XI., XII.,XIII, PT, INR, aPTT, AT III, fibrinogen, platlets count, FDP, D-dimer…) 10 7 E vvt 2 E/ vvt 810EEFFP FFP 39 éves ffi 12000 500 gr2fibrinogén EEEvvt PPC PPC „C” tipusú medencetörés 23 gr8fibrinogén E Tct 24hólyagsérülés mikrogr 12 E Tct DDAVP HEPTEM INTEM heparin EXTEM Rapid TEG abciximab cytochalasin D APTEM aprotinin Fibrinolysis FIBTEM
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