Background: Hyperfibrinolysis is a critical component of coagulopathy with poor outcomes if not diagnosed and treated early. Successful hemostasis management requires close monitoring of fibrinolysis and its targeted treatment with anti-fibrinolytics (where applicable, in addition to initial TXA).

Aims: The study objective was to explore and compare the fibrinolysis detection capabilities of viscoelastic hemostatic analyzers (VHA) under controlled conditions.

Methods: Previous (TEG® 5000, ROTEM® Delta; n=140) and new generation (TEG® 6s, ROTEM® Sigma; n=160 (duplicate measurements)) viscoelastic analyses were performed on healthy volunteers tPA (0-140ng/ml) contrived whole blood samples. Fibrinolysis was measured with TEG® at 30 minutes after maximum amplitude (LY30) for RapidTEG® (CRT) and Kaolin (CK) assays and with ROTEM® at 30 minutes after clotting time (LI30) for INTEM and EXTEM assays. Device relationships to tPA were studied in linear or nonlinear models and measurement variances were studied with Bland-Altman analyses.

Results: Both analyzers showed a monotonic relationship with increased tPA concentrations in log-logistic four parametric models. Differences were observed between TEG and ROTEM on the probability of tPA induced lysis detection. The lowest study concentration with sensitivity levels above 70% for Lysis prediction versus reference range was 60ng/ml for CK.LY30 and CRT.LY30, 80ng/ml for EXTEM.LI30 and 100ng/ml INTEM.LI30. In comparison, current commonly used VHA-guided thresholds for fibrinolysis treatment corresponded to ~80ng/ml or higher. All devices had specificity levels >80% at most studied concentrations. Finally, the new generation devices variance of measurements ranged from 1.6% (CRT.LY30) and 3.7% (CK.LY30) for the TEG®6s to 11.9% (EXTEM.LI30) and 15.8% (INTEM.LI30) for the ROTEM® Sigma.

Conclusions: Important differences were found between fibrinolysis detection capabilities of the VHA analyzers in vitro. The clinical importance of these findings needs to be further investigated. VHA-guided fibrinolysis treatment algorithms could potentially be adjusted in line with the sensitivity of the new VHA analyzers.

[Model based minimum detectable tPA induced lysis]

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/fibrinolysis-detection-by-teg-and-rotem-viscoelastic-analysers-an-in-vitro-comparison/