Rotational thromboelastometry in therapy of life threatening bleeding

Authors: Miroslav Durila
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny 2. LF UK a FN Motol, Praha
Published in: Vnitř Lék 2018; 64(4): 380-383
Category: Reviews


Bleeding and coagulopathy is a common problem in the fields of internal medicine. In case of life-threatening bleeding, rotational thromboelastometry (ROTEM) has critical role in diagnosis and therapy of coagulopathy. In contrast to commonly used tests such as prothrombin time and activated partial thromboplastin time, ROTEM evaluates coagulation of the whole blood as a bedside method. The use of ROTEM for rapid diagnosis and targeted therapy of coagulopathy leads to reduction in bleeding and thus to reduction in administration of blood transfusion products. ROTEM is a viscoelastic method incorporated in current European and Czech-Slovak guidelines for managing life-threatening bleeding. In this article, we provide the reader with information on the method and also a simple scheme for the treatment of coagulopathy guided by ROTEM.

Key words:
bleeding – coagulopathy – thromboelastometry


1. Matlach R, Makovický P, Makovický P. Letální případy krvácení do horní části gastrointestinálního traktu. Vnitř Lék 2016; 62(12): 1028–1033.

2. Hoffman M, Monroe DM. A cell-based model of hemostasis. Thromb Haemost 2001; 85(6): 958–965.

3. Mann KG, Brummel K, Butenas S. What is all that thrombin for? J Thromb Haemost 2003; 1(7): 1504–1514.

4. Durila M, Beroušek J, Vymazal T. Rutinné používanie tromboelastometrie (ROTEM) k hodnoteniu koagulácie (adopcia ,,novej“ paradigmy hodnotenia koagulácie) na jednotke intenzívnej starostlivosti vedie k značnému zníženiu podávania krvnej plazmy. Transfuze Hematol dnes 2016; 22(3): 168–171.

5. Gorlinger K, Saner FH. Prophylactic plasma and platelet transfusion in the critically Ill patient: just useless and expensive or even harmful? BMC Anesthesiol 2015; 15: 86. Dostupné z DOI: <–015–0074–0>.

6. Mohammed M, Fayed n, Hassanen A et al. Rotational thromboelastometry and standard coagulation tests for live liver donors. Clin Transplant 2013; 27(2): E101-E108. Dostupné z DOI: <>.

7. Urwyler N, Theiler L, Hirschberg M et al. Standard vs. point-of-care measurement of fibrinogen: potential impact on clinical decisions. Minerva Anestesiol 2012; 78(5): 550–555.

8. Haas T, Spielmann N, Mauch J et al. Comparison of thromboelastometry (ROTEM(R)) with standard plasmatic coagulation testing in paediatric surgery. Br J Anaesth 2012; 108(1): 36–41. Dostupné z DOI: <>.

9. Keene DD, Nordmann GR, Wolley T. Rotational thromboelastometry-guided trauma resuscitation. Curr Opin Crit Care 2013; 19(6): 605–612. Dostupné z DOI: <>.

10. Hagemo JS, Christiaans SC, Stanworth SJ et al. Detection of acute traumatic coagulopathy and massive transfusion requirements by means of rotational thromboelastometry: an international prospective validation study. Crit Care 2015; 19: 97. Dostupné z DOI: <–015–0823-y>.

11. Huissoud C, Carrabin N, Audibert F et al. Bedside assessment of fibrinogen level in postpartum haemorrhage by thrombelastometry. BJOG 2009; 116(8): 1097–1102. Dostupné z DOI: <–0528.2009.02187.x>.

12. Rossaint R, Bouillon B, Cerny V et al. The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Crit Care 2016; 20: 100. Dostupné z DOI: <–016–1265-x>.

13. Blatný J, Bláha J, Cvachovec K et al. Diagnostika a léčba život ohrožujícího krvácení u dospľlých pacientô v intenzivní a perioperační péči. Anest intenziv Med 2017; 28(4): 263–269.

Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 4

2018 Issue 4

Most read in this issue

This topic is also in:

Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account