OBJECTIVE: Since the previous comprehensive radiology review on coagulation concepts that was done in 1990, many studies have been published in the medical and surgical literature that can guide the approach of a radiology practice. The purpose of this article is to provide an analysis of these works, updating the radiologist on proper use and interpretation of coagulation assessment tools, medications that modify the hemostatic system, and the use of transfusions prior to interventions. CONCLUSION: The basic tools for coagulation assessment have not changed; however, results from subspecialty research have suggested ways in which the use of these tools can be modified and streamlined to safely reduce time and expense for the patient and the health care system.
"As an example, a cirrhotic patient with low platelet count and an abnormal INR of 2 does not necessarily bleed and probably can tolerate minor invasive procedures. In contrast, a hypothermic trauma patient with normal platelet count and INR might bleed to death [3,4]. Another limitation of traditional lab tests is the prolonged time to obtain the results or turnaround time. "
[Show abstract][Hide abstract] ABSTRACT: Transfusion in trauma is often empiric or based on traditional lab tests. Viscoelastic tests such as thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®) have been proposed as superior to traditional lab tests. Due to the similarities between the two tests, general opinion seems to consider them equivalent with interchangeable interpretations. However, it is not clear whether the results can be similarly interpreted. This review evaluates the comparability between TEG and ROTEM and performs a descriptive review of the parameters utilized in each test in adult trauma patients.
PUBMED database was reviewed using the keywords "thromboelastography" and "compare", between 2000 and 2011. Original studies directly comparing TEG® with ROTEM® in any area were retrieved. To verify the individual test parameter used in studies involving trauma patients, we further performed a review using the keywords "thromboelastography" and "trauma" in the PUBMED database.
Only 4 studies directly compared TEG® with ROTEM®. One in liver transplantation found that transfusion practice could differ depending on the device in use. Another in cardiac surgery concluded that all measurements are not completely interchangeable. The third article using commercially available plasma detected clinically significant differences in the results from the two devices. The fourth one was a head-to-head comparison of the technical aspects. The 24 articles reporting the use of viscoelastic tests in trauma patients, presented considerable heterogeneity.
Both tests are potentially useful as means to rapidly diagnose coagulopathy, guide transfusion and determine outcome in trauma patients. Differences in the activators utilized in each device limit the direct comparability. Standardization and robust clinical trials comparing the two technologies are needed before these tests can be widely recommended for clinical use in trauma.
World Journal of Emergency Surgery 08/2012; 7 Suppl 1(Suppl 1):S3. DOI:10.1186/1749-7922-7-S1-S3 · 1.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: The purpose of this article is to discuss the history of, indications and rationale for, and approach to imaging-guided percutaneous renal biopsies. CONCLUSION: With the progressive increase in the number of incidentally discovered renal masses, increased use of percutaneous ablation as a treatment alternative for the management of renal cell carcinoma and improvements in immunohistochemistry techniques, imaging-guided renal biopsy will continue to serve as a useful tool for the evaluation and management of renal diseases.
American Journal of Roentgenology 06/2010; 194(6):1443-9. DOI:10.2214/AJR.10.4427 · 2.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: An essential component of neurosurgical critical care and routine delivery of neurosurgical services is an understanding of bleeding and clotting disorders. Patients with coagulopathies can present with difficulty forming or maintaining normal clotting or show a hypercoagulable state. Any coagulopathy can have serious consequences in the setting of neurosurgical care including cranial or spinal surgery, trauma, or spinal cord injury. On the basis of the most current peer-reviewed literature, we present recommendations for assessment, treatment, and surveillance of coagulopathy in the neurosurgical patient.
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