Therapeutic plasma exchange in heart transplantation: role of coagulation assessment with thromboelastometry

JA Clinical Reports

Table 1 Types of assays on rotational thromboelastometry

Test	TF	Contact	Heparin effect	Detectable condition(s)	Hemostatic interventions
EXTEM	+		−^a	Extrinsic pathway, PLT count, fibrinolysis	Plasma, PCC, or PLTs
FIBTEM	+		−^a	Fibrinogen level^b	Cryo or fibrinogen conc.
APTEM	+		−^a	Systemic fibrinolysis^c	Antifibrinolytics
INTEM		+	+	Intrinsic pathway, PLT count, fibrinolysis	Plasma, protamine, or PLTs
HEPTEM		+	−^a	Heparin effect	Same as INTEM

ACT activated clotting time, Cryo cryoprecipitate, Fibrinogen conc. fibrinogen concentrate, PCC prothrombin complex concentrate, PLT platelet, TF tissue factor activator, Contact contact activator (ellagic acid)
^aHeparin is neutralized by the reagent at concentrations up to 4–6 U/ml on EXTEM/FIBTEM/APTEM and 8 U/ml on HEPTEM
^bConfirmatory test for hypofibrinogenemia; low clot firmness (amplitude) on other ROTEM® tests may indicate either thrombocytopenia or hypofibrinogenemia
^cConfirmatory test for fibrinolysis; fibrinolysis may be shown on all the other ROTEM® tests