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Comparison of fibrin-based clot elasticity parameters measured by free oscillation rheometry (ReoRox ®) versus thromboelastometry (ROTEM ®).

Solomon C, Schöchl H, Ranucci M, Schött U, Schlimp CJ - Scand. J. Clin. Lab. Invest. (2015)

Bottom Line: Hemodilution decreased clot strength.Both Fibscreen2 G'max and FIBTEM parameters decreased proportionally to the dilution ratio when saline was used.The observed reductions in FIBTEM and Fibscreen2 parameters were more severe in samples diluted with gelatin and HES, compared to saline.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Perioperative Medicine and General Intensive Care, Paracelsus Medical University , Salzburg , Austria.

ABSTRACT

Background: Whole blood viscoelastic tests such as the fibrin-based thromboelastometry (ROTEM(®)) test FIBTEM are increasingly used in the perioperative setting to quickly identify deficits in fibrin quality, and to guide hemostatic therapy. The recently developed FibScreen2 test of the ReoRox(®) method, based on free oscillation rheometry, also provides an evaluation of fibrin clot quality. To date, little information is available on the performance of this test in hemodiluted blood, by comparison to FIBTEM.

Methods: Whole blood samples from eight healthy volunteers were analyzed using FIBTEM and Fibscreen2. Native and diluted (to 33% and 50% using saline, gelatin or hydroxyethyl starch [HES]) samples were analyzed. Clot strength parameters, including FIBTEM maximum clot firmness (MCF), FIBTEM maximum clot elasticity (MCE) and Fibscreen2 maximum elasticity (G'max), were measured.

Results: In repeatedly measured samples from two volunteers, FIBTEM MCF and Fibscreen2 G'max revealed a coefficient of variation (CV) of 5.3 vs. 16.3% and 5.6 vs. 31.7% for each volunteer, respectively. Hemodilution decreased clot strength. Both Fibscreen2 G'max and FIBTEM parameters decreased proportionally to the dilution ratio when saline was used. The observed reductions in FIBTEM and Fibscreen2 parameters were more severe in samples diluted with gelatin and HES, compared to saline. Finally, a regression analysis between FIBTEM MCE and Fibscreen2 G'max revealed a poor goodness of fit (r(2) = 0.37, p < 0.0001).

Conclusions: ReoRox(®) Fibscreen2 test has a high coefficient of variation, and its application in various hemodilution conditions showed limited comparability with the ROTEM(®) FIBTEM test.

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Comparison of functional fibrinogen in undiluted and diluted re-calcified citrated blood samples obtained with the ROTEM® and ReoRox® devices. Blood samples were diluted at 33% and 50% with saline (NaCl), gelatin (GEL) and hydroxyethyl starch (HES). Duplicates of each dilution of blood samples from six different volunteers were evaluated with (A) the derived FIBTEM maximum clot elasticity (MCE) and (B) Fibscreen2 maximum elasticity (G'max). For each group, the median is represented by a bar within a box (extending from the 25th to 75th percentiles). Whiskers extend from the smallest to the largest values.
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Figure 2: Comparison of functional fibrinogen in undiluted and diluted re-calcified citrated blood samples obtained with the ROTEM® and ReoRox® devices. Blood samples were diluted at 33% and 50% with saline (NaCl), gelatin (GEL) and hydroxyethyl starch (HES). Duplicates of each dilution of blood samples from six different volunteers were evaluated with (A) the derived FIBTEM maximum clot elasticity (MCE) and (B) Fibscreen2 maximum elasticity (G'max). For each group, the median is represented by a bar within a box (extending from the 25th to 75th percentiles). Whiskers extend from the smallest to the largest values.

Mentions: Using blood samples from six volunteers, FIBTEM and Fibscreen2 data showed a decrease in fibrin-based clot strength as a consequence of hemodilution, in samples diluted with saline, gelatin or HES (Figure 2A, B). The decrease in the median FIBTEM MCF was proportional to the dilution when saline was used, with a 50% decrease when samples were diluted by 50% with saline (Table II). A comparable behavior was observed with most other FIBTEM parameters: A10, A20, and MCE parameters decreased by 57.1%, 53.3% and 54.3%, respectively, and the A5 was decreased by 64.3% in samples diluted by 50% with saline. Similarly, the median Fibscreen2 G'max decreased by 57.1% in samples diluted by 50% with saline (Table II). In contrast, FIBTEM and Fibscreen2 parameters were more affected by hemodilution when gelatin or HES was used, with decreases ranging from 71.0% (Fibscreen2 G'max) to 78.6% (FIBTEM A5 and A10) in samples diluted by 50% with gelatin and from 79.1% (Fibscreen2 G'max) to 88.6% (FIBTEM MCE) in samples diluted by 50% with HES (Figure 2A, B; Table II).


Comparison of fibrin-based clot elasticity parameters measured by free oscillation rheometry (ReoRox ®) versus thromboelastometry (ROTEM ®).

Solomon C, Schöchl H, Ranucci M, Schött U, Schlimp CJ - Scand. J. Clin. Lab. Invest. (2015)

Comparison of functional fibrinogen in undiluted and diluted re-calcified citrated blood samples obtained with the ROTEM® and ReoRox® devices. Blood samples were diluted at 33% and 50% with saline (NaCl), gelatin (GEL) and hydroxyethyl starch (HES). Duplicates of each dilution of blood samples from six different volunteers were evaluated with (A) the derived FIBTEM maximum clot elasticity (MCE) and (B) Fibscreen2 maximum elasticity (G'max). For each group, the median is represented by a bar within a box (extending from the 25th to 75th percentiles). Whiskers extend from the smallest to the largest values.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4389733&req=5

Figure 2: Comparison of functional fibrinogen in undiluted and diluted re-calcified citrated blood samples obtained with the ROTEM® and ReoRox® devices. Blood samples were diluted at 33% and 50% with saline (NaCl), gelatin (GEL) and hydroxyethyl starch (HES). Duplicates of each dilution of blood samples from six different volunteers were evaluated with (A) the derived FIBTEM maximum clot elasticity (MCE) and (B) Fibscreen2 maximum elasticity (G'max). For each group, the median is represented by a bar within a box (extending from the 25th to 75th percentiles). Whiskers extend from the smallest to the largest values.
Mentions: Using blood samples from six volunteers, FIBTEM and Fibscreen2 data showed a decrease in fibrin-based clot strength as a consequence of hemodilution, in samples diluted with saline, gelatin or HES (Figure 2A, B). The decrease in the median FIBTEM MCF was proportional to the dilution when saline was used, with a 50% decrease when samples were diluted by 50% with saline (Table II). A comparable behavior was observed with most other FIBTEM parameters: A10, A20, and MCE parameters decreased by 57.1%, 53.3% and 54.3%, respectively, and the A5 was decreased by 64.3% in samples diluted by 50% with saline. Similarly, the median Fibscreen2 G'max decreased by 57.1% in samples diluted by 50% with saline (Table II). In contrast, FIBTEM and Fibscreen2 parameters were more affected by hemodilution when gelatin or HES was used, with decreases ranging from 71.0% (Fibscreen2 G'max) to 78.6% (FIBTEM A5 and A10) in samples diluted by 50% with gelatin and from 79.1% (Fibscreen2 G'max) to 88.6% (FIBTEM MCE) in samples diluted by 50% with HES (Figure 2A, B; Table II).

Bottom Line: Hemodilution decreased clot strength.Both Fibscreen2 G'max and FIBTEM parameters decreased proportionally to the dilution ratio when saline was used.The observed reductions in FIBTEM and Fibscreen2 parameters were more severe in samples diluted with gelatin and HES, compared to saline.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Perioperative Medicine and General Intensive Care, Paracelsus Medical University , Salzburg , Austria.

ABSTRACT

Background: Whole blood viscoelastic tests such as the fibrin-based thromboelastometry (ROTEM(®)) test FIBTEM are increasingly used in the perioperative setting to quickly identify deficits in fibrin quality, and to guide hemostatic therapy. The recently developed FibScreen2 test of the ReoRox(®) method, based on free oscillation rheometry, also provides an evaluation of fibrin clot quality. To date, little information is available on the performance of this test in hemodiluted blood, by comparison to FIBTEM.

Methods: Whole blood samples from eight healthy volunteers were analyzed using FIBTEM and Fibscreen2. Native and diluted (to 33% and 50% using saline, gelatin or hydroxyethyl starch [HES]) samples were analyzed. Clot strength parameters, including FIBTEM maximum clot firmness (MCF), FIBTEM maximum clot elasticity (MCE) and Fibscreen2 maximum elasticity (G'max), were measured.

Results: In repeatedly measured samples from two volunteers, FIBTEM MCF and Fibscreen2 G'max revealed a coefficient of variation (CV) of 5.3 vs. 16.3% and 5.6 vs. 31.7% for each volunteer, respectively. Hemodilution decreased clot strength. Both Fibscreen2 G'max and FIBTEM parameters decreased proportionally to the dilution ratio when saline was used. The observed reductions in FIBTEM and Fibscreen2 parameters were more severe in samples diluted with gelatin and HES, compared to saline. Finally, a regression analysis between FIBTEM MCE and Fibscreen2 G'max revealed a poor goodness of fit (r(2) = 0.37, p < 0.0001).

Conclusions: ReoRox(®) Fibscreen2 test has a high coefficient of variation, and its application in various hemodilution conditions showed limited comparability with the ROTEM(®) FIBTEM test.

Show MeSH
Related in: MedlinePlus