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Thromboelastography (TEG) Or Thromboelastometry (ROTEM) to Monitor Haemostatic Treatment Versus Usual Care in Adults Or Children with Bleeding (Review)

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Thromboelastography (TEG) Or Thromboelastometry (ROTEM) to Monitor Haemostatic Treatment Versus Usual Care in Adults Or Children with Bleeding (Review) Cochrane Database of Systematic Reviews Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding (Review) Wikkelsø A, Wetterslev J, Møller AM, Afshari A Wikkelsø A, Wetterslev J, Møller AM, Afshari A. Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding. Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD007871. DOI: 10.1002/14651858.CD007871.pub3. www.cochranelibrary.com Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding (Review) Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLEOFCONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 SUMMARYOFFINDINGSFORTHEMAINCOMPARISON . 4 Figure1. ..................................... 7 Figure2. ..................................... 8 Figure3. ..................................... 9 Figure4. ..................................... 10 Figure5. ..................................... 11 BACKGROUND .................................... 11 OBJECTIVES ..................................... 13 METHODS...................................... 13 Figure6. ..................................... 15 RESULTS....................................... 19 Figure7. ..................................... 20 Figure8. ..................................... 21 Figure9. ..................................... 23 Figure10. ..................................... 24 ADDITIONALSUMMARYOFFINDINGS . 29 DISCUSSION ..................................... 36 AUTHORS’CONCLUSIONS . 39 ACKNOWLEDGEMENTS . 40 REFERENCES ..................................... 40 CHARACTERISTICSOFSTUDIES . 46 DATAANDANALYSES. 87 Analysis 1.1. Comparison 1 TEG or ROTEM versus any comparison, Outcome 1 Mortality; grouped by TEG or ROTEM. ................................... 90 Analysis 1.2. Comparison 1 TEG or ROTEM versus any comparison, Outcome 2 Mortality; grouped by coagulopathy or severe postoperative bleeding status. 91 Analysis 1.3. Comparison 1 TEG or ROTEM versus any comparison, Outcome 3 Patients receiving PRBCs; grouped by TEGorROTEM. ................................ 92 Analysis 1.4. Comparison 1 TEG or ROTEM versus any comparison, Outcome 4 Patients receiving PRBCs; grouped by adult or paediatric patients. 94 Analysis 1.5. Comparison 1 TEG or ROTEM versus any comparison, Outcome 5 Patients receiving PRBCs; grouped by coagulopathy or severe postoperative bleeding status. 95 Analysis 1.6. Comparison 1 TEG or ROTEM versus any comparison, Outcome 6 Patients receiving FFP; grouped by TEG orROTEM. .................................. 96 Analysis 1.7. Comparison 1 TEG or ROTEM versus any comparison, Outcome 7 Patients receiving FFP; grouped by coagulopathy or severe postoperative bleeding status. 97 Analysis 1.8. Comparison 1 TEG or ROTEM versus any comparison, Outcome 8 Patients receiving platelets; grouped by TEGorROTEM. ................................ 98 Analysis 1.9. Comparison 1 TEG or ROTEM versus any comparison, Outcome 9 Patients receiving platelets; grouped by adult or paediatric patients. 99 Analysis 1.10. Comparison 1 TEG or ROTEM versus any comparison, Outcome 10 Patients receiving platelets; grouped by coagulopathy or severe postoperative bleeding status. 100 Analysis 1.11. Comparison 1 TEG or ROTEM versus any comparison, Outcome 11 Transfusion of FFP & platelets. 101 Analysis 1.12. Comparison 1 TEG or ROTEM versus any comparison, Outcome 12 Patients receiving fibrinogen concentrate. 101 Analysis 1.13. Comparison 1 TEG or ROTEM versus any comparison, Outcome 13 Patients receiving prothrombin complex concentrate (PCC). 102 Analysis 1.14. Comparison 1 TEG or ROTEM versus any comparison, Outcome 14 Patients receiving factor VIIa. 103 Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or i children with bleeding (Review) Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Analysis 1.15. Comparison 1 TEG or ROTEM versus any comparison, Outcome 15 Surgical reintervention; grouped by coagulopathy or severe postoperative bleeding status. 104 Analysis 1.16. Comparison 1 TEG or ROTEM versus any comparison, Outcome 16 Surgical reintervention; grouped by TEGorROTEM. ................................ 105 Analysis 1.17. Comparison 1 TEG or ROTEM versus any comparison, Outcome 17 Dialysis-dependent renal failure. 106 Analysis 1.18. Comparison 1 TEG or ROTEM versus any comparison, Outcome 18 Thrombotic events. 107 Analysis 1.19. Comparison 1 TEG or ROTEM versus any comparison, Outcome 19 Surgical source of re-bleeding. 108 Analysis 1.20. Comparison 1 TEG or ROTEM versus any comparison, Outcome 20 Excessive bleeding events and massive transfusion. .................................. 109 Analysis 1.21. Comparison 1 TEG or ROTEM versus any comparison, Outcome 21 Post hoc: mortality; grouped by comparison. .................................. 110 Analysis 1.22. Comparison 1 TEG or ROTEM versus any comparison, Outcome 22 Post hoc: patients receiving PRBCs; groupedbycomparisons.. 111 Analysis 1.23. Comparison 1 TEG or ROTEM versus any comparison, Outcome 23 Post hoc: patients receiving FFP; groupedbycomparison. 112 Analysis 2.1. Comparison 2 TEG or ROTEM versus clinical judgement or usual care, Outcome 1 Mortality. 113 Analysis 2.2. Comparison 2 TEG or ROTEM versus clinical judgement or usual care, Outcome 2 Patients receiving PRBCs..................................... 114 Analysis 2.3. Comparison 2 TEG or ROTEM versus clinical judgement or usual care, Outcome 3 Patients receiving FFP...................................... 115 Analysis 2.4. Comparison 2 TEG or ROTEM versus clinical judgement or usual care, Outcome 4 Patients receiving platelets. ................................... 116 Analysis 2.5. Comparison 2 TEG or ROTEM versus clinical judgement or usual care, Outcome 5 Surgical reintervention. 117 Analysis 3.1. Comparison 3 TEG or ROTEM versus SLT-guided transfusion, Outcome 1 Mortality. 118 Analysis 3.2. Comparison 3 TEG or ROTEM versus SLT-guided transfusion, Outcome 2 Patients receiving PRBCs. 119 Analysis 3.3. Comparison 3 TEG or ROTEM versus SLT-guided transfusion, Outcome 3 Patients receiving FFP. 120 Analysis 3.4. Comparison 3 TEG or ROTEM versus SLT-guided transfusion, Outcome 4 Patients receiving platelets. 121 Analysis 3.5. Comparison 3 TEG or ROTEM versus SLT-guided transfusion, Outcome 5 Surgical reintervention. 122 Analysis 4.1. Comparison 4 TEG or ROTEM in combination with SLT or other devices versus clinical judgement or usual care, Outcome 1 Mortality. 123 Analysis 4.2. Comparison 4 TEG or ROTEM in combination with SLT or other devices versus clinical judgement or usual care, Outcome 2 Patients receiving PRBCs. 124 Analysis 4.3. Comparison 4 TEG or ROTEM in combination with SLT or other devices versus clinical judgement or usual care, Outcome 3 Patients receiving FFP. 125 Analysis 4.4. Comparison 4 TEG or ROTEM in combination with SLT or other devices versus clinical judgement or usual care, Outcome 4 Patients receiving platelets. 126 Analysis 4.5. Comparison 4 TEG or ROTEM in combination with SLT or other devices versus clinical judgement or usual care, Outcome 5 Surgical reintervention. 127 ADDITIONALTABLES. 127 APPENDICES ..................................... 142 WHAT’SNEW..................................... 143 HISTORY....................................... 144 CONTRIBUTIONSOFAUTHORS . 145 DECLARATIONSOFINTEREST . 146 SOURCESOFSUPPORT . 146 DIFFERENCESBETWEENPROTOCOLANDREVIEW . 146 INDEXTERMS .................................... 146 Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or ii children with bleeding (Review) Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. [Intervention Review] Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding Anne Wikkelsø1, Jørn Wetterslev2, Ann Merete Møller3, Arash Afshari4 1Department of Anaesthesiology and Intensive Care Medicine, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark. 2Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 3Cochrane Anaesthesia, Critical and Emergency Care Group, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark. 4Juliane Marie Centre - Anaesthesia and Surgical Clinic Department 4013, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark Contact address: Arash Afshari, Juliane Marie Centre - Anaesthesia and Surgical Clinic Department 4013, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. [email protected], [email protected]. Editorial group: Cochrane Emergency and Critical Care Group. Publication status and date: Edited (no change to conclusions), published in Issue 12, 2018. Citation: Wikkelsø A, Wetterslev J, Møller AM, Afshari A. Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding. Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD007871. DOI: 10.1002/14651858.CD007871.pub3. Copyright © 2018 The Cochrane Collaboration. Published
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