A Primer for Clinical Use of Rotational Thromboelastometry

Rotational thromboelastometry (ROTEM) has gained popularity in Europe as a practical tool in coagulation management. ROTEM was recently approved for clinical use by the Food and Drug Administration. A comprehensive diagnosis of coagulopathy is feasible using various tests on ROTEM, which can differentially demonstrate procoagulant factor(s) deficiency, thrombocytopenia, hypofibrinogenemia, and profibrinolytic state. A long turnaround time (>30 minutes) of laboratory coagulation tests is not practical for transfusion management in bleeding trauma/surgical patients. By implementing ROTEM testing, hemostatic interventions can be more individualized, goal-directed (targeted) instead of empirically transfusing multiple plasma products. The use of transfusion algorithms and point-of-care coagulation monitoring has become important considering potential hazards of plasma products and precious blood resource allocations. In this review, principles and practical applications of ROTEM in hemostatic management will be discussed in comparison with standard coagulation testing.