Guide to Therapy Based on ROTEM Results.
Guide to Therapy Based on ROTEM Results. C.22. What is thromboelastometry? How can it guide transfusion? C.22. What is thromboelastometry? How can it guide transfusion?
«Flowchart»

Microvascular Bleeding

Microvascular Bleeding

Microvascular Bleeding

End

End

End

and/or

and/or

and/or

ROTEM + Coagulation tests

ROTEM + Coagulation tests

ROTEM + Coagulation tests

All normal

All normal

All normal

MCF Extem <48 mm
and
MCF Extem ≥10 mm

MCF Extem <48 mm
and
MCF Extem ≥10 mm



≥ MCF Extem <48 mm

MCF Extem <10 mm

MCF Extem <10 mm

MCF Extem <10 mm

CT Extem >100 sec
and/or
CT Intem >240 sec

CT Extem >100 sec
and/or
CT Intem >240 sec



CT Extem >100 sec

ML Extem >15%

ML Extem >15%

ML Extem >15%

and/or

and/or

and/or

and/or

and/or

and/or

Surgical Exploration

Surgical Exploration

Surgical Exploration

Tranexamic acid
or
Aminocapronic acid

Tranexamic acid
or
Aminocapronic acid

Tranexamic acid
or
Aminocapronic acid



Platelets <100 * 109/L

Platelets <100 * 109/L

Platelets <100 * 109/L

* 9

Platelets

Platelets

Platelets

Fibrinogen <1.5 g/L

Fibrinogen <1.5 g/L

Fibrinogen <1.5 g/L

Cryoprecipitates
and/or
Fibrinogen concentrate

Cryoprecipitates
and/or
Fibrinogen concentrate

Cryoprecipitates
and/or
Fibrinogen concentrate



PT/aPTT >1.5* normal

PT/aPTT >1.5* normal

PT/aPTT >1.5* normal

*

FFP
and/or
PCC

FFP
and/or
PCC

FFP
and/or
PCC



aPTT, activated partial thromboplastin time; CT, computed tomography; FFP, fresh frozen plasma; MCF, maximum clot firmness; ML, maximum lysis; PCC, prothrombin complex concentrate; PT, prothrombin time.

aPTT, activated partial thromboplastin time; CT, computed tomography; FFP, fresh frozen plasma; MCF, maximum clot firmness; ML, maximum lysis; PCC, prothrombin complex concentrate; PT, prothrombin time.

aPTT, activated partial thromboplastin time; CT, computed tomography; FFP, fresh frozen plasma; MCF, maximum clot firmness; ML, maximum lysis; PCC, prothrombin complex concentrate; PT, prothrombin time.