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16.06.2021 | Review

The use of thromboelastography (TEG) and rotational thromboelastometry (ROTEM) in neonates: a systematic review

verfasst von: Georgios Ν. Katsaras, Rozeta Sokou, Andreas G. Tsantes, Daniele Piovani, Stefanos Bonovas, Aikaterini Konstantinidi, Georgios Ioakeimidis, Stauroula Parastatidou, Dimitra Gialamprinou, Athanasia Makrogianni, Georgios Mitsiakos, Argirios Ε. Tsantes

Erschienen in: European Journal of Pediatrics | Ausgabe 12/2021

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Abstract

“Developmental hemostasis” refers to the dynamic process of gradual hemostatic maturation. Conventional coagulation tests seem to fail to accurately depict the in vivo hemostasis, while viscoelastic tests, thromboelastography (TEG), and rotational thromboelastometry (ROTEM) appear very promising as they provide insight more rapidly and accurately into the hemostatic potential. We systematically reviewed the literature in PubMed to examine the use of TEG and ROTEM in neonates. Our search yielded 34 studies, of which 18 concerned healthy neonates and 16 sick neonates. These viscoelastic tests have shown accelerated initiation of coagulation, increased clot strength, and increased fibrinolysis in healthy neonates compared to children and adults. Cord blood leads to a hypercoagulable state as compared to whole blood when testing is performed with TEG. Pre-term neonates have a more hypocoagulable profile, but balanced hemostasis, related to term neonates, that evolves to a more procoagulant phenotype over the first month of life. Critically ill neonates exhibit a more hypocoagulable profile as compared to healthy neonates. TEG and ROTEM have shown predictive value for bleeding events in critically ill neonates and neonates undergoing cardiopulmonary bypass or therapeutic hypothermia.

Conclusion: TEG and ROTEM need to become part of the standard coagulation assessment in clinical settings in which hemostatic abnormalities are involved, as they seem to provide more rapid and accurate information regarding the hemostatic profile of the neonates. Their predictive value for bleeding events in critically ill neonates could lead to a more targeted therapy optimizing utilization of blood products.

What is Known:

• Conventional coagulation tests seem to fail to accurately depict the in vivo hemostasis.

• TEG and ROTEM delineate more rapidly and accurately the hemostatic potential.

What is New:

• TEG and ROTEM have shown predictive value for bleeding events.

• TEG and ROTEM may lead to a more targeted transfusion therapy optimizing utilization of blood products.

Andrew M, Paes B, Milner R, Johnston M, Mitchell L, Tollefsen DM, Powers P (1987) Development of the human coagulation system in the full-term infant. Blood. 70(1):165–172CrossRefPubMed

Konstantinidi A, Sokou R, Parastatidou S, Lampropoulou K, Katsaras G, Boutsikou T, Gounaris AK, Tsantes AE, Iacovidou N (2019) Clinical application of thromboelastography/thromboelastometry (TEG/TEM) in the neonatal population: a narrative review. Semin Thromb Hemost 45(05):449–457. https://doi.org/10.1055/s-0039-1692210CrossRefPubMed

Hoffman M, Monroe D (2001) A cell-based model of hemostasis. Thromb Haemost 85(06):958–965. https://doi.org/10.1055/s-0037-1615947CrossRefPubMed

Haas T, Fries D, Tanaka KA, Asmis L, Curry NS, Schöchl H (2015) Usefulness of standard plasma coagulation tests in the management of perioperative coagulopathic bleeding: is there any evidence? Br J Anaesth 114(2):217–224. https://doi.org/10.1093/bja/aeu303CrossRefPubMed

Schmidt AE, Israel AK, Refaai MA (2019) The utility of thromboelastography to guide blood product transfusion. Am J Clin Pathol 152(4):407–422. https://doi.org/10.1093/ajcp/aqz074CrossRefPubMed

Veigas PV, Callum J, Rizoli S, Nascimento B, da Luz LT (2016) A systematic review on the rotational thrombelastometry (ROTEM®) values for the diagnosis of coagulopathy, prediction and guidance of blood transfusion and prediction of mortality in trauma patients. Scand J Trauma Resusc Emerg Med 24(1):114. https://doi.org/10.1186/s13049-016-0308-2CrossRefPubMedPubMedCentral

Oswald E, Stalzer B, Heitz E, Weiss M, Schmugge M, Strasak A, Innerhofer P, Haas T (2010) Thromboelastometry (ROTEM ® ) in children: age-related reference ranges and correlations with standard coagulation tests. Br J Anaesth 105(6):827–835. https://doi.org/10.1093/bja/aeq258CrossRefPubMed

Del Vecchio A, Franco C, Petrillo F, D’Amato G (2016) Neonatal transfusion practice: when do neonates need red blood cells or platelets? Am J Perinatol 33(11):1079–1084. https://doi.org/10.1055/s-0036-1586106CrossRefPubMed

Serraino GF, Murphy GJ (2017) Routine use of viscoelastic blood tests for diagnosis and treatment of coagulopathic bleeding in cardiac surgery: updated systematic review and meta-analysis. Br J Anaesth 118(6):823–833. https://doi.org/10.1093/bja/aex100CrossRefPubMed

10.

Wikkelsø A, Wetterslev J, Møller AM, Afshari A (2017) Thromboelastography (TEG) or rotational thromboelastometry (ROTEM) to monitor haemostatic treatment in bleeding patients: a systematic review with meta-analysis and trial sequential analysis. Anaesthesia. 72(4):519–531. https://doi.org/10.1111/anae.13765CrossRefPubMed

11.

Najafi A, Nikeish M, Etezadi F, Pourfakhr P, Imani F, Khajavi MR, Shariat Moharari R (2015) Comparison of aPTT and CT parameter of the ROTEM test to monitor heparin anti-coagulation effect in ICU patients: an observational study. Acta Med Iran 53(10):643–646PubMed

12.

Mittermayr M, Velik-Salchner C, Stalzer B, Margreiter J, Klingler A, Streif W, Fries D, Innerhofer P (2009) Detection of protamine and heparin after termination of cardiopulmonary bypass by thrombelastometry (ROTEM®): results of a pilot study. Anesth Analg 108(3):743–750. https://doi.org/10.1213/ane.0b013e31818657a3CrossRefPubMed

13.

Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097CrossRefPubMedPubMedCentral

14.

Mahasandana C, Hathaway WE (1973) Circulating anticoagulants in the newborn: relation to hypercoagulability and the idiopathic respiratory distress syndrome. Pediatr Res 7(7):670–672. https://doi.org/10.1203/00006450-197307000-00010CrossRef

15.

Suzuki S, Wake N, Yoshiaki K (1976) New neonatal problems of blood coagulation and fibrinolysis. J Perinat Med 4:213–220. https://doi.org/10.1515/jpme.1976.4.4.213CrossRefPubMed

16.

Kettner SC, Pollak A, Zimpfer M, Seybold T, Prusa AR, Herkner K, Kuhle S (2004) Heparinase-modified thrombelastography in term and preterm neonates. Anesth Analg 98(6):1650–1652. https://doi.org/10.1213/01.ANE.0000115149.25496.DDCrossRefPubMed

17.

Cvirn G, Gallistl S, Kutschera J, Wagner T, Ferstl U, Jurgens G, Koestenberger M (2008) Clot strength: a comparison between cord and adult blood by means of thrombelastometry. J Pediatr Hematol Oncol 30(3):210–213. https://doi.org/10.1097/MPH.0b013e318162bd2cCrossRefPubMed

18.

Edwards RM, Naik-Mathuria BJ, Gay AN, Olutoye OO, Teruya J (2008) Parameters of thromboelastography in healthy newborns. Am J Clin Pathol 130(1):99–102. https://doi.org/10.1309/LABNMY41RUD099J2CrossRefPubMed

19.

Strauss T, Levy-Shraga Y, Ravid B, Schushan-Eisen I, Maayan-Metzger A, Kuint J, Kenet G (2010) Clot formation of neonates tested by thromboelastography correlates with gestational age. Thromb Haemost 103(02):344–350. https://doi.org/10.1160/TH09-05-0282CrossRefPubMed

20.

Ravn HB, Andreasen JB, Hvas A-M (2017) Does whole blood coagulation analysis reflect developmental haemostasis? Blood Coagul Fibrinolysis 28(3):218–223. https://doi.org/10.1097/MBC.0000000000000585CrossRefPubMed

21.

Sidlik R, Strauss T, Morag I, Shenkman B, Tamarin I, Lubetsky A, Livnat T, Kenet G (2016) Assessment of functional fibrinolysis in cord blood using modified thromboelastography. Pediatr Blood Cancer 63(5):839–843. https://doi.org/10.1002/pbc.25865CrossRefPubMed

22.

Mirabella L, Cotoia A, Colacicco G, Tullo L, Salatto P, Mollica G et al (2017) Reference values for coagulation assessment in full-term newborns. Minerva Anestesiol 83(4):369–374. https://doi.org/10.23736/S0375-9393.16.11375-6CrossRefPubMed

23.

Motta M, Guaragni B, Pezzotti E, Rodriguez-Perez C, Chirico G (2017) Reference intervals of citrated-native whole blood thromboelastography in premature neonates. Early Hum Dev 115(September):60–63. https://doi.org/10.1016/j.earlhumdev.2017.09.014CrossRefPubMed

24.

Sewell EK, Forman KR, Wong ECC, Gallagher M, Luban NLC, Massaro AN (2017) Thromboelastography in term neonates: an alternative approach to evaluating coagulopathy. Arch Dis Child Fetal Neonatal Ed 102(1):F79–F84. https://doi.org/10.1136/archdischild-2016-310545CrossRefPubMed

25.

Schott NJ, Emery SP, Garbee C, Waters J (2018) Thromboelastography in term neonates. J Matern Neonatal Med 31(19):2599–2604. https://doi.org/10.1080/14767058.2017.1349747CrossRef

26.

Sokou R, Foudoulaki-Paparizos L, Lytras T, Konstantinidi A, Theodoraki M, Lambadaridis I, Gounaris A, Valsami S, Politou M, Gialeraki A, Nikolopoulos GK, Iacovidou N, Bonovas S, Tsantes AE (2017) Reference ranges of thromboelastometry in healthy full-term and pre-term neonates. Clin Chem Lab Med 55(10):1592–1597. https://doi.org/10.1515/cclm-2016-0931CrossRefPubMed

27.

Liu Q, Xu C, Chen X, Wang J, Ke Z, Hu H (2019) Establishing a reference range for thromboelastograph parameters in the neonatal period. Int J Lab Hematol 41(4):530–535. https://doi.org/10.1111/ijlh.13043CrossRefPubMedPubMedCentral

28.

Raffaeli G, Tripodi A, Cavallaro G, Cortesi V, Scalambrino E, Pesenti N, Artoni A, Mosca F, Ghirardello S (2020) Thromboelastographic profiles of healthy very low birthweight infants serially during their first month. Arch Dis Child Fetal Neonatal Ed 105(4):412–418. https://doi.org/10.1136/archdischild-2019-317860CrossRefPubMed

29.

Sokou R, Konstantinidi A, Stefanaki C, Tsantes AG, Parastatidou S, Lampropoulou K, Katsaras G, Tavoulari E, Iacovidou N, Kyriakou E, Gounaris A, Bonovas S, Tsantes AE (2019) Thromboelastometry: studying hemostatic profile in small for gestational age neonates—a pilot observational study. Eur J Pediatr 178(4):551–557. https://doi.org/10.1007/s00431-019-03331-wCrossRefPubMed

30.

Raffaeli G, Tripodi A, Manzoni F, Scalambrino E, Pesenti N, Amodeo I, Cavallaro G, Villamor E, Peyvandi F, Mosca F, Ghirardello S (2020) Is placental blood a reliable source for the evaluation of neonatal hemostasis at birth? Transfusion. 60(5):1069–1077. https://doi.org/10.1111/trf.15785CrossRefPubMed

31.

Theodoraki M, Sokou R, Valsami S, Iliodromiti Z, Pouliakis A, Parastatidou S, Karavana G, Ioakeimidis G, Georgiadou P, Iacovidou N, Boutsikou T (2020) Reference values of thrombolastometry parameters in healthy term neonates. Children. 7(12):259. https://doi.org/10.3390/children7120259CrossRefPubMedCentral

32.

Stammers AH, Willett L, Fristoe L, Merrill J, Stover T, Hunt A, Morrow J, Newberry J (1995) Coagulation monitoring during extracorporeal membrane oxygenation: the role of thrombelastography. J Extra Corpor Technol 27(3):137–145PubMed

33.

Grant HW, Hadley GP (1997) Prediction of neonatal sepsis by thromboelastography. Pediatr Surg Int 12(4):289–292. https://doi.org/10.1007/BF01372152CrossRefPubMed

34.

Haizinger B, Gombotz H, Rehak P, Geiselseder G, Mair R (2006) Activated thrombelastogram in neonates and infants with complex congenital heart disease in comparison with healthy children. Br J Anaesth 97(4):545–552. https://doi.org/10.1093/bja/ael206CrossRefPubMed

35.

Forman KR, Wong E, Gallagher M, McCarter R, Luban NLC, Massaro AN (2014) Effect of temperature on thromboelastography and implications for clinical use in newborns undergoing therapeutic hypothermia. Pediatr Res 75(5):663–669. https://doi.org/10.1038/pr.2014.19CrossRefPubMedPubMedCentral

36.

Radicioni M, Bruni A, Bini V, Villa A, Ferri C (2015) Thromboelastographic profiles of the premature infants with and without intracranial hemorrhage at birth: a pilot study. J Matern Neonatal Med 28(15):1779–1783. https://doi.org/10.3109/14767058.2014.968773CrossRef

37.

Kim JY, Shin YR, Kil HK, Park MR, Lee JW (2016) Reference intervals of thromboelastometric evaluation of coagulation in pediatric patients with congenital heart diseases: a retrospective investigation. Med Sci Monit 22:3576–3587. https://doi.org/10.12659/MSM.901256CrossRefPubMedPubMedCentral

38.

Sokou R, Giallouros G, Konstantinidi A, Pantavou K, Nikolopoulos G, Bonovas S, Lytras T, Kyriakou E, Lambadaridis I, Gounaris A, Douramani P, Valsami S, Kapsimali V, Iacovidou N, Tsantes AE (2018) Thromboelastometry for diagnosis of neonatal sepsis-associated coagulopathy: an observational study. Eur J Pediatr 177(3):355–362. https://doi.org/10.1007/s00431-017-3072-zCrossRefPubMed

39.

Peterson JA, Maroney SA, Zwifelhofer W, Wood JP, Yan K, Bercovitz RS, Woods RK, Mast AE (2018) Heparin-protamine balance after neonatal cardiopulmonary bypass surgery. J Thromb Haemost 16(10):1973–1983. https://doi.org/10.1111/jth.14245CrossRefPubMedPubMedCentral

40.

Scott JP, Niebler RA, Stuth EAE, Newman DK, Tweddell JS, Bercovitz RS, Benson DW, Cole R, Simpson PM, Yan K, Woods RK (2018) Rotational thromboelastometry rapidly predicts thrombocytopenia and hypofibrinogenemia during neonatal cardiopulmonary bypass. World J Pediatr Congenit Hear Surg 9(4):424–433. https://doi.org/10.1177/2150135118771318CrossRef

41.

Ghirardello S, Raffaeli G, Crippa BL, Gulden S, Amodeo I, Consonni D, Cavallaro G, Schena F, Mosca F (2020) The thromboelastographic profile at birth in very preterm newborns with patent ductus arteriosus. Neonatology. 117(3):316–323. https://doi.org/10.1159/000507553CrossRefPubMed

42.

Konstantinidi A, Sokou R, Tsantes AG, Parastatidou S, Bonovas S, Kouskouni E, Gounaris AK, Tsantes AE, Iacovidou N (2020) Thromboelastometry variables in neonates with perinatal hypoxia. Semin Thromb Hemost 46(04):428–434. https://doi.org/10.1055/s-0040-1709473CrossRefPubMed

43.

Lampridou M, Sokou R, Tsantes AG, Theodoraki M, Konstantinidi A, Ioakeimidis G, Bonovas S, Politou M, Valsami S, Iliodromiti Z, Boutsikou T, Iacovidou N, Nikolopoulos G, Tsantes AE (2020) ROTEM diagnostic capacity for measuring fibrinolysis in neonatal sepsis. Thromb Res 192:103–108. https://doi.org/10.1016/j.thromres.2020.05.028CrossRefPubMed

44.

Phillips RC, Shahi N, Leopold D, Levek C, Shirek G, Hilton S, Hyslop R, Gien J, Kinsella JP, Buckvold S, Liechty KW, Kim JS, Marwan AI (2020) Thromboelastography-guided management of coagulopathy in neonates with congenital diaphragmatic hernia supported by extracorporeal membrane oxygenation. Pediatr Surg Int 36(9):1027–1033. https://doi.org/10.1007/s00383-020-04694-0CrossRefPubMed

45.

Snyder CW, Goldenberg NA, Nguyen ATH, Smithers CJ, Kays DW (2020) A perioperative bivalirudin anticoagulation protocol for neonates with congenital diaphragmatic hernia on extracorporeal membrane oxygenation. Thromb Res 193(April):198–203. https://doi.org/10.1016/j.thromres.2020.07.043CrossRefPubMed

46.

Parastatidou S, Sokou R, Tsantes AG, Konstantinidi A, Lampridou M, Ioakeimidis G, Panagiotounakou P, Kyriakou E, Kokoris S, Gialeraki A, Douramani P, Iacovidou N, Piovani D, Bonovas S, Nikolopoulos G, Tsantes AE (2021) The role of ROTEM variables based on clot elasticity and platelet component in predicting bleeding risk in thrombocytopenic critically ill neonates. Eur J Haematol 106(2):175–183. https://doi.org/10.1111/ejh.13534CrossRefPubMed

47.

Sokou R, Piovani D, Konstantinidi A, Tsantes AG, Parastatidou S, Lampridou M, Ioakeimidis G, Gounaris A, Iacovidou N, Kriebardis AG, Politou M, Kopterides P, Bonovas S, Tsantes AE (2021) A risk score for predicting the incidence of hemorrhage in critically ill neonates: development and validation study. Thromb Haemost 121(02):131–139. https://doi.org/10.1055/s-0040-1715832CrossRefPubMed

48.

Revel-vilk S (2012) The conundrum of neonatal coagulopathy. Am Soc Hematol Educ Progr 2012:450–454CrossRef

49.

Andrew M, Paes B, Milner R, Johnston M, Mitchell L, Tollefsen DM, Castle V, Powers P (1988) Development of the human coagulation system in the healthy premature infant. Blood. 72(5):1651–1657CrossRefPubMed

50.

Francis JL, Armstrong DJ (1982) Sialic acid and enzymatic desialation of cord blood fibrinogen. Pathophysiol Haemost Thromb 11(4):223–228. https://doi.org/10.1159/000214667CrossRef

51.

Pinacho A, Páramo JA, Ezcurdia M, Rocha E (1995) Evaluation of the fibrinolytic system in full-term neonates. Int J Clin Lab Res 25(3):149–152. https://doi.org/10.1007/BF02592557CrossRefPubMed

52.

Ignjatovic V, Kenet G, Monagle P (2012) Perinatal and Paediatric Haemostasis Subcommittee of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Developmental hemostasis: recommendations for laboratories reporting pediatric samples. J Thromb Haemost 10(2):298–300. https://doi.org/10.1111/j.1538-7836.2011.04584.xCrossRefPubMed

53.

Guzzetta NA, Allen NN, Wilson EC, Foster GS, Ehrlich AC, Miller BE (2015 Feb) Excessive postoperative bleeding and outcomes in neonates undergoing cardiopulmonary bypass. Anesth Analg 120(2):405–410. https://doi.org/10.1213/ANE.0000000000000531CrossRefPubMed

54.

Wolberg AS, Meng ZH, Monroe DM, Hoffman M (2004) A systematic evaluation of the effect of temperature on coagulation enzyme activity and platelet function. J Trauma Inj Infect Crit Care 56(6):1221–1228. https://doi.org/10.1097/01.TA.0000064328.97941.FCCrossRef

55.

Peker E, Akbayram S, Geylani H, Dogan M, Kirimi E (2011) Global fibrinolytic capacity in neonatal sepsis. Clin Appl Thromb 17(6):E64–E69. https://doi.org/10.1177/1076029610384113CrossRef

56.

Bauman ME, Cheung P-Y, Massicotte MP (2011) Hemostasis and platelet dysfunction in asphyxiated neonates. J Pediatr 158(2):e35–e39. https://doi.org/10.1016/j.jpeds.2010.11.011CrossRefPubMed

Titel: The use of thromboelastography (TEG) and rotational thromboelastometry (ROTEM) in neonates: a systematic review
verfasst von: Georgios Ν. Katsaras
Rozeta Sokou
Andreas G. Tsantes
Daniele Piovani
Stefanos Bonovas
Aikaterini Konstantinidi
Georgios Ioakeimidis
Stauroula Parastatidou
Dimitra Gialamprinou
Athanasia Makrogianni
Georgios Mitsiakos
Argirios Ε. Tsantes
Publikationsdatum: 16.06.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Pediatrics / Ausgabe 12/2021
Print ISSN: 0340-6199
Elektronische ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-021-04154-4

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