thrombelastography

Summary

Summary: Use of a thrombelastograph, which provides a continuous graphic record of the physical shape of a clot during fibrin formation and subsequent lysis.

Top Publications

  1. Harr J, Moore E, Ghasabyan A, Chin T, Sauaia A, Banerjee A, et al. Functional fibrinogen assay indicates that fibrinogen is critical in correcting abnormal clot strength following trauma. Shock. 2013;39:45-9 pubmed publisher
    ..These data suggest that fibrinogen should be addressed early in trauma patients manifesting acute coagulopathy of trauma...
  2. Cotton B, Harvin J, Kostousouv V, Minei K, Radwan Z, Schöchl H, et al. Hyperfibrinolysis at admission is an uncommon but highly lethal event associated with shock and prehospital fluid administration. J Trauma Acute Care Surg. 2012;73:365-70; discussion 370 pubmed publisher
    ..To further strengthen this hypothesis, we created an in vitro hemodilution model to improve our mechanistic understanding of the early HF...
  3. Ostrowski S, Sørensen A, Larsen C, Johansson P. Thrombelastography and biomarker profiles in acute coagulopathy of trauma: a prospective study. Scand J Trauma Resusc Emerg Med. 2011;19:64 pubmed publisher
    Severe injury induces an acute coagulopathy associated with increased mortality. This study compared the Thrombelastography (TEG) and biomarker profiles upon admission in trauma patients...
  4. Theusinger O, Wanner G, Emmert M, Billeter A, Eismon J, Seifert B, et al. Hyperfibrinolysis diagnosed by rotational thromboelastometry (ROTEM) is associated with higher mortality in patients with severe trauma. Anesth Analg. 2011;113:1003-12 pubmed publisher
    ..Rotational thromboelastometry provides real-time recognition of hyperfibrinolysis allowing early treatment. ..
  5. Pezold M, Moore E, Wohlauer M, Sauaia A, Gonzalez E, Banerjee A, et al. Viscoelastic clot strength predicts coagulation-related mortality within 15 minutes. Surgery. 2012;151:48-54 pubmed publisher
    ..We hypothesized that clot strength (G) measured by point-of-care rapid thrombelastography (r-TEG) on arrival in the emergency department can predict massive transfusion (MT) and coagulation-related ..
  6. Kawano Castillo J, Ward E, Elliott A, Wetzel J, Hassler A, McDonald M, et al. Thrombelastography detects possible coagulation disturbance in patients with intracerebral hemorrhage with hematoma enlargement. Stroke. 2014;45:683-8 pubmed publisher
    Intracerebral hemorrhage (ICH) has high morbidity, and hematoma enlargement (HE) causes worse outcome. Thrombelastography (TEG) measures the dynamics of clot formation and dissolution, and might be useful for assessing bleeding risk...
  7. Kreutz R, Owens J, Breall J, Lu D, von Der Lohe E, Bolad I, et al. C-reactive protein and fibrin clot strength measured by thrombelastography after coronary stenting. Blood Coagul Fibrinolysis. 2013;24:321-6 pubmed publisher
    ..Heightened whole blood clot strength measured by thrombelastography (TEG) has been associated with adverse ischaemic events after stenting...
  8. Ogawa S, Szlam F, Bolliger D, Nishimura T, Chen E, Tanaka K. The impact of hematocrit on fibrin clot formation assessed by rotational thromboelastometry. Anesth Analg. 2012;115:16-21 pubmed publisher
  9. Schöchl H, Cotton B, Inaba K, Nienaber U, Fischer H, Voelckel W, et al. FIBTEM provides early prediction of massive transfusion in trauma. Crit Care. 2011;15:R265 pubmed publisher
    ..83). FIBTEM A10 and FIBTEM MCF provided similar predictive values for massive transfusion in trauma patients to the most predictive laboratory parameters. Prospective studies are needed to confirm these findings. ..

More Information

Publications61

  1. Rafiq S, Johansson P, Ostrowski S, Stissing T, Steinbrüchel D. Hypercoagulability in patients undergoing coronary artery bypass grafting: prevalence, patient characteristics and postoperative outcome. Eur J Cardiothorac Surg. 2012;41:550-5 pubmed publisher
    ..5% of CABG patients, and the findings of this study support the notion that TEG-hypercoagulable patients have a higher risk for a combination of thromboembolic complications and death after surgery. ..
  2. Görlinger K, Dirkmann D, Hanke A, Kamler M, Kottenberg E, Thielmann M, et al. First-line therapy with coagulation factor concentrates combined with point-of-care coagulation testing is associated with decreased allogeneic blood transfusion in cardiovascular surgery: a retrospective, single-center cohort study. Anesthesiology. 2011;115:1179-91 pubmed publisher
    ..24 vs. 5.22%; P = 0.98). First-line administration of coagulation factor concentrates combined with point-of-care testing was associated with decreased incidence of blood transfusion and thrombotic/thromboembolic events. ..
  3. Johansson P, Sørensen A, Larsen C, Windeløv N, Stensballe J, Perner A, et al. Low hemorrhage-related mortality in trauma patients in a Level I trauma center employing transfusion packages and early thromboelastography-directed hemostatic resuscitation with plasma and platelets. Transfusion. 2013;53:3088-99 pubmed publisher
    ..Hemorrhage accounts for most preventable trauma deaths, but still the optimal strategy for hemostatic resuscitation remains debated...
  4. Ostrowski S, Windeløv N, Ibsen M, Haase N, Perner A, Johansson P. Consecutive thrombelastography clot strength profiles in patients with severe sepsis and their association with 28-day mortality: a prospective study. J Crit Care. 2013;28:317.e1-11 pubmed publisher
    The aim of this study was to assess associations between consecutive thrombelastography (TEG) profiles and standard coagulation tests and disease severity and mortality in patients with severe sepsis...
  5. Agarwal B, Wright G, Gatt A, Riddell A, Vemala V, Mallett S, et al. Evaluation of coagulation abnormalities in acute liver failure. J Hepatol. 2012;57:780-6 pubmed publisher
    ..In ALF, despite grossly deranged PT in all patients, estimation of bleeding risk suggests that the coagulation disturbance in ALF patients is complex and heterogeneous for which an individualised approach is required. ..
  6. Wohlauer M, Moore E, Thomas S, Sauaia A, Evans E, Harr J, et al. Early platelet dysfunction: an unrecognized role in the acute coagulopathy of trauma. J Am Coll Surg. 2012;214:739-46 pubmed publisher
    ..Although the current debate on acute traumatic coagulopathy has focused on the consumption or inhibition of coagulation factors, the question of early platelet dysfunction in this setting remains unclear...
  7. Nystrup K, Windeløv N, Thomsen A, Johansson P. Reduced clot strength upon admission, evaluated by thrombelastography (TEG), in trauma patients is independently associated with increased 30-day mortality. Scand J Trauma Resusc Emerg Med. 2011;19:52 pubmed publisher
    ..Prospective randomized trials investigating this potential are highly warranted. ..
  8. Holcomb J, Minei K, Scerbo M, Radwan Z, Wade C, Kozar R, et al. Admission rapid thrombelastography can replace conventional coagulation tests in the emergency department: experience with 1974 consecutive trauma patients. Ann Surg. 2012;256:476-86 pubmed publisher
    Injury and shock lead to alterations in conventional coagulation tests (CCTs). Recently, rapid thrombelastography (r-TEG) has become recognized as a comprehensive assessment of coagulation abnormalities...
  9. Godier A, Miclot A, Le Bonniec B, Durand M, Fischer A, Emmerich J, et al. Evaluation of prothrombin complex concentrate and recombinant activated factor VII to reverse rivaroxaban in a rabbit model. Anesthesiology. 2012;116:94-102 pubmed publisher
    ..Regarding safety, neither rFVIIa nor PCC increased cyclic flow reductions. rFVIIa and PCC partially improved laboratory parameters, but did not reverse rivaroxaban induced-bleeding. ..
  10. Haas T, Spielmann N, Mauch J, Madjdpour C, Speer O, Schmugge M, et al. Comparison of thromboelastometry (ROTEM®) with standard plasmatic coagulation testing in paediatric surgery. Br J Anaesth. 2012;108:36-41 pubmed publisher
    ..A good correlation was found between the fibrinogen level and the FibTEM assay. In addition, ROTEM(®) offered faster turnaround times. ..
  11. Macafee B, Campbell J, Ashpole K, Cox M, Matthey F, Acton L, et al. Reference ranges for thromboelastography (TEG(®) ) and traditional coagulation tests in term parturients undergoing caesarean section under spinal anaesthesia*. Anaesthesia. 2012;67:741-7 pubmed publisher
    ..The standard coagulation reference ranges were within 98% of the local non-pregnant ranges. These reference ranges provide a useful comparator for peri-operative TEG and routine coagulation analysis in term parturients. ..
  12. Honickel M, Rieg A, Rossaint R, Braunschweig T, Spronk H, ten Cate H, et al. Prothrombin complex concentrate reduces blood loss and enhances thrombin generation in a pig model with blunt liver injury under severe hypothermia. Thromb Haemost. 2011;106:724-33 pubmed publisher
    ..Furthermore, the impact and safety of PCC application can be monitored through thrombin generation and thromboelastometry under hypothermia. ..
  13. Armstrong S, Fernando R, Ashpole K, Simons R, Columb M. Assessment of coagulation in the obstetric population using ROTEM® thromboelastometry. Int J Obstet Anesth. 2011;20:293-8 pubmed publisher
    ..0001). ROTEM® thromboelastometry clearly demonstrates the hypercoagulability of pregnancy. Formal reference ranges for ROTEM® that may be potentially useful in the haemostatic management of the parturient are presented. ..
  14. Cotton B, Minei K, Radwan Z, Matijevic N, Pivalizza E, Podbielski J, et al. Admission rapid thrombelastography predicts development of pulmonary embolism in trauma patients. J Trauma Acute Care Surg. 2012;72:1470-5; discussion 1475-7 pubmed publisher
    ..A comprehensive assessment of these coagulation abnormalities can be measured and described by thrombelastography. The purpose of this study was to identify whether admission rapid-thrombelastography (r-TEG) could identify ..
  15. Solomon C, Sørensen B, Hochleitner G, Kashuk J, Ranucci M, Schöchl H. Comparison of whole blood fibrin-based clot tests in thrombelastography and thromboelastometry. Anesth Analg. 2012;114:721-30 pubmed publisher
    ..Our objective was to compare clot firmness parameters through standard (FF on a thrombelastography device [TEG®]; FIBTEM on a thromboelastometry device [ROTEM®]) and crossover (FF on ROTEM®; FIBTEM on TEG..
  16. Hartog C, Reuter D, Loesche W, Hofmann M, Reinhart K. Influence of hydroxyethyl starch (HES) 130/0.4 on hemostasis as measured by viscoelastic device analysis: a systematic review. Intensive Care Med. 2011;37:1725-37 pubmed publisher
    ..Systematic review of studies assessing HES 130/0.4 effects on hemostasis by thrombelastography (TEG, ROTEM) or Sonoclot (SCR) in comparison with crystalloid or albumin control fluids was performed...
  17. Tsai H, Tsao C, Liao M, Ka S, Liaw W, Wu C. Application of thrombelastography in liver injury induced by endotoxin in rat. Blood Coagul Fibrinolysis. 2012;23:118-26 pubmed publisher
    Liver injury developing in patients with sepsis may lead to an increased risk of mortality. Thrombelastography (TEG) is generally applied to evaluate hemostatic disturbance in patients undergoing liver transplantation or cardiopulmonary ..
  18. Görlinger K, Dirkmann D, Solomon C, Hanke A. Fast interpretation of thromboelastometry in non-cardiac surgery: reliability in patients with hypo-, normo-, and hypercoagulability. Br J Anaesth. 2013;110:222-30 pubmed publisher
    ..Early values of clot firmness allow for fast and reliable prediction of ROTEM(®) MCF in non-cardiac patients with subnormal, normal, and supranormal MCF values and therefore can be used to guide haemostatic therapy in severe bleeding. ..
  19. Bolliger D, Tanaka K. Roles of thrombelastography and thromboelastometry for patient blood management in cardiac surgery. Transfus Med Rev. 2013;27:213-20 pubmed publisher
    The value of thrombelastography (TEG) and thromboelastometry (ROTEM) to improve perioperative hemostasis is under debate...
  20. Johansson P. Coagulation monitoring of the bleeding traumatized patient. Curr Opin Anaesthesiol. 2012;25:235-41 pubmed publisher
    ..Instead viscoelastic haemostatic assays (VHAs) such as thrombelastography and rotation thromboelastometry should be used...
  21. Ostrowski S, Johansson P. Endothelial glycocalyx degradation induces endogenous heparinization in patients with severe injury and early traumatic coagulopathy. J Trauma Acute Care Surg. 2012;73:60-6 pubmed publisher
    ..This study evaluated if degradation of the endothelial glycocalyx and ensuing release of its heparin-like substances induce autoheparinization and thereby contributes to TIC...
  22. Brenner T, Schmidt K, Delang M, Mehrabi A, Bruckner T, Lichtenstern C, et al. Viscoelastic and aggregometric point-of-care testing in patients with septic shock - cross-links between inflammation and haemostasis. Acta Anaesthesiol Scand. 2012;56:1277-90 pubmed publisher
    ..hypocoagulability) and therefore identified patients at high risk for overt disseminated intravascular coagulation. ..
  23. Raza I, Davenport R, Rourke C, Platton S, Manson J, Spoors C, et al. The incidence and magnitude of fibrinolytic activation in trauma patients. J Thromb Haemost. 2013;11:307-14 pubmed publisher
    ..5 million deaths annually from hemorrhage and coagulopathy. Overt hyperfibrinolysis is rare in trauma, and is associated with massive fatal injuries. Paradoxically, clinical trials suggest a much broader indication for antifibrinolytics...
  24. Collyer T, Gray D, Sandhu R, Berridge J, Lyons G. Assessment of platelet inhibition secondary to clopidogrel and aspirin therapy in preoperative acute surgical patients measured by Thrombelastography Platelet Mapping. Br J Anaesth. 2009;102:492-8 pubmed publisher
    ..The Thrombelastography Platelet Mapping (TEG-PM) assay is designed to assess platelet inhibition secondary to antiplatelet therapy...
  25. Collins P, Macchiavello L, Lewis S, Macartney N, Saayman A, Luddington R, et al. Global tests of haemostasis in critically ill patients with severe sepsis syndrome compared to controls. Br J Haematol. 2006;135:220-7 pubmed
    ..005). In conclusion, global tests of haemostasis suggest that in this patient group, activation of haemostasis is delayed but once initiated thrombin generation and clot formation are normal or enhanced. ..
  26. Nielsen V, Cankovic L, Steenwyk B. Epsilon-aminocaproic acid inhibition of fibrinolysis in vitro: should the 'therapeutic' concentration be reconsidered?. Blood Coagul Fibrinolysis. 2007;18:35-9 pubmed
    ..containing 0, 13, 65 or 130 microg/ml EACA, with clot growth/disintegration kinetics quantified via thrombelastography. Data were analyzed with one-way analysis of variance or Kruskal-Wallis analysis of variance as appropriate...
  27. Johansson P, Svendsen M, Salado J, Bochsen L, Kristensen A. Investigation of the thrombin-generating capacity, evaluated by thrombogram, and clot formation evaluated by thrombelastography of platelets stored in the blood bank for up to 7 days. Vox Sang. 2008;94:113-8 pubmed
    ..of thrombin generation, as evaluated by CAT, correlates with the thrombus generation, as evaluated by thrombelastography and this may in part explain the clinical utility of the TEG in identifying clinically relevant ..
  28. Lang T, Toller W, Gütl M, Mahla E, Metzler H, Rehak P, et al. Different effects of abciximab and cytochalasin D on clot strength in thrombelastography. J Thromb Haemost. 2004;2:147-53 pubmed
    Maximum amplitude (MA) in thrombelastography (TEG) consists of a plasmatic and a platelet component. To assess the magnitude of the plasmatic component, pharmacological approaches have been proposed to eliminate the platelet component...
  29. Plotkin A, Wade C, Jenkins D, Smith K, Noe J, Park M, et al. A reduction in clot formation rate and strength assessed by thrombelastography is indicative of transfusion requirements in patients with penetrating injuries. J Trauma. 2008;64:S64-8 pubmed publisher
    Bleeding is a major cause of death in patients with traumatic injuries. Recently, thrombelastography (TEG) has been suggested as an additional means of evaluating coagulation in trauma patients...
  30. Larsen O, Fenger Eriksen C, Christiansen K, Ingerslev J, Sørensen B. Diagnostic performance and therapeutic consequence of thromboelastometry activated by kaolin versus a panel of specific reagents. Anesthesiology. 2011;115:294-302 pubmed publisher
  31. Kashuk J, Moore E, Sabel A, Barnett C, Haenel J, Le T, et al. Rapid thrombelastography (r-TEG) identifies hypercoagulability and predicts thromboembolic events in surgical patients. Surgery. 2009;146:764-72; discussion 772-4 pubmed publisher
    ..Emerging evidence suggests that point of care (POC) rapid thrombelastography (r-TEG) provides a real-time analysis of comprehensive thrombostatic function, which represents an analysis ..
  32. Warnaar N, Molenaar I, Colquhoun S, Slooff M, Sherwani S, De Wolf A, et al. Intraoperative pulmonary embolism and intracardiac thrombosis complicating liver transplantation: a systematic review. J Thromb Haemost. 2008;6:297-302 pubmed
    ..001). Intraoperative PE and ICT during OLT appear to have multiple etiologies and may occur unexpectedly at any time during the procedure. ..
  33. Paltrinieri S, Meazza C, Giordano A, Tunesi C. Validation of thromboelastometry in horses. Vet Clin Pathol. 2008;37:277-85 pubmed publisher
    ..The equine thromboelastogram is similar to that of other species, but reference intervals vary with aptitude and exercise. Hemolysis and refrigeration alter thromboelastometric results. ..
  34. Bolliger D, Szlam F, Molinaro R, Rahe Meyer N, Levy J, Tanaka K. Finding the optimal concentration range for fibrinogen replacement after severe haemodilution: an in vitro model. Br J Anaesth. 2009;102:793-9 pubmed publisher
    ..Although improved, clots were prone to fibrinolysis indicating that the efficacy of fibrinogen therapy may be influenced by co-existing fibrinolytic tendency occurring during dilutional coagulopathy. ..
  35. Schöchl H, Forster L, Woidke R, Solomon C, Voelckel W. Use of rotation thromboelastometry (ROTEM) to achieve successful treatment of polytrauma with fibrinogen concentrate and prothrombin complex concentrate. Anaesthesia. 2010;65:199-203 pubmed publisher
    ..This case shows the potential success of treatment using both fibrinogen concentrate and prothrombin complex concentrate, not only in restoring haemostasis but also in minimising requirement for transfusion of allogeneic blood products...
  36. Zambruni A, Thalheimer U, Leandro G, Perry D, Burroughs A. Thromboelastography with citrated blood: comparability with native blood, stability of citrate storage and effect of repeated sampling. Blood Coagul Fibrinolysis. 2004;15:103-7 pubmed
    ..Thus, citrated blood can be used as a surrogate of native blood in assessing coagulation using TEG, but if repeated sampling is used the trend in hypercoagulability must be considered. ..
  37. Korte W, Szadkowski C, Gähler A, Gabi K, Kownacki E, Eder M, et al. Factor XIII substitution in surgical cancer patients at high risk for intraoperative bleeding. Anesthesiology. 2009;110:239-45 pubmed publisher
    ..Further clinical trials are needed to assess relevant clinical endpoints such as blood loss, loss of other coagulation factors, and use of blood products. ..
  38. Godier A, Durand M, Smadja D, Jeandel T, Emmerich J, Samama C. Maize- or potato-derived hydroxyethyl starches: is there any thromboelastometric difference?. Acta Anaesthesiol Scand. 2010;54:1241-7 pubmed publisher
    ..Both the starch preparations tested lead to more severe haemostatic defects than crystalloids, and impairment of fibrin polymerization appears to be a leading determinant of this coagulopathy. ..
  39. Rajpal G, Pomerantz J, Ragni M, Waters J, Vallejo M. The use of thromboelastography for the peripartum management of a patient with platelet storage pool disorder. Int J Obstet Anesth. 2011;20:173-7 pubmed publisher
    ..The use of thromboelastography in the assessment and management of bleeding risk in the setting of platelet storage pool disorder is described. ..
  40. Przkora R, Euliano T, Roussos Ross K, Zumberg M, Robicsek S. Labor and delivery in a patient with hemophilia B. Int J Obstet Anesth. 2011;20:250-3 pubmed publisher
    ..Operative vaginal delivery and invasive fetal monitoring should be avoided. Thromboelastography is an excellent technique to assess parturients with bleeding disorders or peripartum hemorrhage and may be underused. ..
  41. Kashuk J, Moore E, Le T, Lawrence J, Pezold M, Johnson J, et al. Noncitrated whole blood is optimal for evaluation of postinjury coagulopathy with point-of-care rapid thrombelastography. J Surg Res. 2009;156:133-8 pubmed publisher
    ..Point-of-care (POC) rapid thrombelastography (r-TEG) provides real time analysis of thrombostatic function, which may allow for accurate, goal directed ..
  42. Rivard G, Brummel Ziedins K, Mann K, Fan L, Hofer A, Cohen E. Evaluation of the profile of thrombin generation during the process of whole blood clotting as assessed by thrombelastography. J Thromb Haemost. 2005;3:2039-43 pubmed
    ..The high magnitude of r and the high significance of the prediction equation demonstrate the high efficacy of the prediction of TAT thrombin generation by the use of TEG TTG. ..
  43. Akay O, Ustuner Z, Canturk Z, Mutlu F, Gulbas Z. Laboratory investigation of hypercoagulability in cancer patients using rotation thrombelastography. Med Oncol. 2009;26:358-64 pubmed publisher
    ..In conclusions, our data demonstrates thromboelastographic signs of hypercoagulability in patients with solid tumors. ROTEM is able to identify the contribution of fibrinogen and platelets to clot strength in this patient population. ..
  44. Agarwal S, Senzolo M, Melikian C, Burroughs A, Mallett S. The prevalence of a heparin-like effect shown on the thromboelastograph in patients undergoing liver transplantation. Liver Transpl. 2008;14:855-60 pubmed publisher
    ..Although it is clear that there are both endogenous and exogenous sources of heparin contributing to the HLE, the clinical significance of these findings remains unclear. ..
  45. Zambruni A, Thalheimer U, Coppell J, Riddell A, Mancuso A, Leandro G, et al. Endogenous heparin-like activity detected by anti-Xa assay in infected cirrhotic and non-cirrhotic patients. Scand J Gastroenterol. 2004;39:830-6 pubmed
    ..In infected non-cirrhotics, anti-Xa activity can also be found. ..
  46. Kashuk J, Moore E, Wohlauer M, Johnson J, Pezold M, Lawrence J, et al. Initial experiences with point-of-care rapid thrombelastography for management of life-threatening postinjury coagulopathy. Transfusion. 2012;52:23-33 pubmed publisher
    Massive transfusion (MTP) protocol design is hindered by lack of accurate assessment of coagulation. Rapid thrombelastography (r-TEG) provides point-of-care (POC) analysis of clot formation...
  47. Chakroun T, Gerotziafas G, Seghatchian J, Samama M, Hatmi M, Elalamy I. The influence of fibrin polymerization and platelet-mediated contractile forces on citrated whole blood thromboelastography profile. Thromb Haemost. 2006;95:822-8 pubmed
    ..Normal platelet contractile forces are of major importance for the maximum amplitude of TEG which is related to the strength and elastic modulus of the thrombus. ..
  48. Park M, Martini W, Dubick M, Salinas J, Butenas S, Kheirabadi B, et al. Thromboelastography as a better indicator of hypercoagulable state after injury than prothrombin time or activated partial thromboplastin time. J Trauma. 2009;67:266-75; discussion 275-6 pubmed publisher
    ..The high incidence of pulmonary embolism indicated that our current prophylaxis regimen could be improved. ..
  49. Schramko A, Suojaranta Ylinen R, Kuitunen A, Kukkonen S, Niemi T. Rapidly degradable hydroxyethyl starch solutions impair blood coagulation after cardiac surgery: a prospective randomized trial. Anesth Analg. 2009;108:30-6 pubmed publisher
    ..In this clinical setting, human albumin does not impair hemostasis. ..
  50. Nielsen V, Cohen B, Cohen E. Effects of coagulation factor deficiency on plasma coagulation kinetics determined via thrombelastography: critical roles of fibrinogen and factors II, VII, X and XII. Acta Anaesthesiol Scand. 2005;49:222-31 pubmed
    b>Thrombelastography (TEG) is used to assess coagulopathy. However, a comprehensive characterization of the effects of specific coagulation factor deficiencies and mode of activation on TEG data does not exist...
  51. Coakley M, Reddy K, Mackie I, Mallett S. Transfusion triggers in orthotopic liver transplantation: a comparison of the thromboelastometry analyzer, the thromboelastogram, and conventional coagulation tests. J Cardiothorac Vasc Anesth. 2006;20:548-53 pubmed
    ..A prospective case-matched study using the viscoelastic tests used in this study would be beneficial in determining the optimal therapy. Rotem fib-TEM monitoring may improve hemostasis management. ..
  52. Chan K, Summerhayes R, Ignjatovic V, Horton S, Monagle P. Reference values for kaolin-activated thromboelastography in healthy children. Anesth Analg. 2007;105:1610-3, table of contents pubmed
    ..In this study, we established reference values for kaolin-activated TEG in healthy children, to facilitate accurate interpretation of pediatric TEG results...