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Table 3 Transfusion algorithm trigger values. Table explaining individual transfusion trigger values in the respective trials included in the meta-analyses

From: The use of viscoelastic haemostatic assays in goal-directing treatment with allogeneic blood products – A systematic review and meta-analysis

Reference (Author and year)

RBC

FFP

Platelets

Other

 

Control group

Intervention group

Control group

Intervention group

Control group

Intervention group

Control group

Intervention group

Shore-Lesserson 1999 [33]

Hct < 25% (during CPB <21%)

Hct < 25% (during CPB <21%)

PT >150% of control (2U FFP)

hTEG R > 20 mm (2U FFP)

PC < 100 · 103/μL (6U PC)

PC < 100 · 103/μL AND TEG MA < 45 mm (6U PC)

Fibrinogen <100 mg/dL 10U of cryo

EACA 10 g if failure

Fibrinogen <100 mg/dL 10U of cryo

LY30 > 7.5% EACA 10 g

Nuttall 2001 [31]

N/A

N/A

Clinician’s discretion with or without CCT

POC PT > 16.6 s and/or POC APTT > 57 s

Clinician’s discretion with or without CCT

PC < 102 · 103/mm3 and/or TEG MA <48 mm (PC or DDAVP)

Clinician’s discretion with or without CCT

Fibrinogen <144 mg/dL – cryo

Royston 2001 [32]

N/A

N/A

Clinician’s discretion with or without CCT

R > 14 mm < 21 mm – 1 FFP

R > 21 mm < 28 mm – 2 FFP

R > 28 mm – 4 FFP

Clinician’s discretion with or without CCT

MA < 48 mm – 1 platelet pool

MA < 40 mm 2 platelet pools

Clinician’s discretion with or without CCT

LY30 > 7.5% - Aprotinin

Avidan 2004 [29]

Hb < 8 g/dL

Hb < 8 g/dL

If still bleeding >100 mL/h after aprotinin + desmopressin AND INR or APTT ratio > 150% control – 4U FFP

Excessive bleeding + R > 10 min – 4U FFP

Persisting excessive bleeding OR PC < 50x109/L – 1 platelet pool

PFA-100® ADP channel > 120 s, epinephrine channel > 170 s treated with DDAVP 0.4 μg/kg – if bleeding persisted 1 platelet pool

Bleeding >100 mL/h within 24 h after surgery – Aprotinin (2 Mu) + desmopressin (0.4 μg/kg)

LY30 > 7.5% + bleeding >100 mL/h – aprotinin 2Mu

PFA-100® ADP channel > 120 s, epinephrine channel > 170 s – DDAVP 0.4 μg/kg

Ak 2009 [28]

Htc < 25% (during CPB <18%)

Htc < 25% (during CPB <18%)

PT > 14 s or APTT > 150% normal

R > 14 mm <21 mm – 1 FFP

R ≥ 21 mm <28 mm – 2 FFP

R ≥ 28 mm – 4 FFP

PC < 100 · 103/μL

40 ≤ MA < 48 mm – 1U platelets

MA < 40 mm 2U platelets

Absence of visible clots + presence of generalized oozing-type bleeding in surgical field – TXA

LY30 > 7.5% - TXA

Westbrook 2009 [35]

Clinician’s discretion with CCT

Hb > 70 g/L

Clinician’s discretion with CCT

11 min < R(H) ≤ 14 min – 1U FFP

14 min < R(H) ≤ 20 min – 2U FFP

200 min < R(H) – 4U FFP

Clinician’s discretion with CCT

MA(H) ≤ 41 mm – 5U platelets

TXA according to clinician’s discretion with CCT

LY30 > 15% - TXA

Girdauskas 2010 [30]

Htc < 25% (Hb 8.5 g/dL) (during CPB Htc < 20% (Hb 6.8 g/dL)) or physiologic transfusion triggers

Htc < 25% (Hb 8.5 g/dL) (during CPB Htc < 20% (Hb 6.8 g/dL)) or physiologic transfusion triggers

PT > 60s or INR >1.5 – FFP 15 mL/kg body mass

HEPTEM CT > 260 s – FFP 15 mL/kg body mass

PC < 100 · 103/μL – 1 platelet concentrate

(A) HEPTEM MCF 35-45 mm – 1 platelet concentrate

(B) FIBTEM MCF >8 mm and HEPTEM MCF <35 mm – 1 platelet concentrate

Fibrinogen <1.2 mg/dL – 2 g fibrinogen

α2-Antiplasmin <80% - 3 g TXA

FIBTEM <8 mm – 2 g fibrinogen

APTEM MCF/HEPTEM MCF >1.5 – 3 g TXA

APTEM CT > 120 s – 3000 IU PPSB

Wang 2010 [37]

Hb <8 g/dL

Hb <8 g/dL

PT and aPTT > 150% control

R > 10 min

PC < 50x109/L

MA < 55 mm – 6-8U pooled platelets

Fibrinogen <1 g/dL – cryo

α-angle < 45° - cryo

Paniagua 2011 [36]

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

Schaden 2012 [38]

Hb <8 g/dL

Hb <8 g/dL

Clinician’s discretion with or without CCT

EXTEM CT > 100 s – 4U FFP

Clinician’s discretion with or without CCT

EXTEM A10 < 45 mm and FIBTEM >12 mm – 1U platelets concentrate

TXA and fibrinogen according to clinician’s discretion with or without CCT

EXTEM A10 < 45 mm and FIBTEM A10 < 12 mm – 2 g fibrinogen

Spindle shaped trace APTEM A10> > EXTEM A10 – 10 mg/kg TXA

EXTEM LY30 > 10% - 10 mg/kg TXA

Weber 2012 [34]

Hb <8 g/dL (during CPB Hb <6 g/dL) or physiologic transfusion triggers

Hb <8 g/dL (during CPB Hb <6 g/dL) or physiologic transfusion triggers

Transfused ≥4U PRBCs without new lab results – 15 mL/kg FFP

INR > 1.4 or aPTT > 50s – 20-30 IU/kg prothrombin complex concentrate or 15 mL/kg FFP

EXTEM CT > 80s or HEPTEM >240 s – 20-30 IU/kg prothrombin complex concentrate or 15 mL/kg FFP

PC < 80000/μL

EXTEM A10 ≤ 40 mm and FIBTEM A10 > 10 mm or TRAP < 50 AU and/or ASPI <30 AU and/or ADP < 30 AU (second choice)

Fibrinogen pre-value < 200 mg/dL or currently <150 mg/dL – 25-50 mg/kg fibrinogen

Suspected platelet dysfunction – 0.3 μg/kg desmopressin

FIBTEM MCF = 0 mm – 25 mg/kg fibrinogen before protamine

EXTEM A10 ≤ 40 mm and FIBTEM A10 ≤ 10 mm – 25-50 mg/kg fibrinogen

TRAP < 50 AU and/or ASPI <30 AU and/or ADP < 30 AU – 0.3 μg/kg desmopressin (first choice)

Barinov 2015 [41]

N/A

N/A

Clinician’s discretion with CCT

N/A

Clinician’s discretion with CCT

N/A

Clinician’s discretion with CCT

N/A

Gonzalez 2015 [22]

First units of RBC administered according to clinician’s discretion only

Hb < 10 g/dL

First units of RBC administered according to clinician’s discretion only

Hb < 10 g/dL

First units of FFP administered according to clinician’s discretion only

INR ≥ 1.5 – 2U FFP

First units of FFP administered according to clinician’s discretion only

ACT 111-139 s – 2U FFP

ACT ≥ 140 s – 2U FFP, 10-pack cryo and 1U apheresis platelets

ACT > 110 s – 2U FFP

PC < 100 · 103/μL – 1U apheresis platelets

ACT ≥ 140 s – 2U FFP, 10-pack cryo and 1U apheresis platelets

MA < 55 mm – 1U apheresis platelets

Fibrinogen >150 mg/dL – 10-pack cryo

Suspicion on fibrinolysis with D-dimer >0.5 μg/dL – 1 g TXA

ACT ≥ 140 s – 2U FFP, 10-pack cryo and 1U apheresis platelets

α-angle < 63° - 10-pack cryo

LY30 ≥ 7.5% - 1 g TXA (after 61% of enrolment LY30 ≥ 3% - 1 g TXA)

De Pietri 2015 [39]

Hb <8 g/dL

Hb <8 g/dL

INR > 1.8 – 10 mL/kg ideal body weight

R > 40 min – 10 mL/kg ideal body weight

PC < 50 · 109/L – 1U PLT

MA < 30 mm – 1U apheresis platelets

  

Cao 2016 [40]

Hb < 70 g/L, Htc < 25% - 2U RBC

Hb < 70 g/L, Htc < 25% - 2U RBC

Clinican’s discretion

R > 8 min – FFP 15 mL/kg

PC < 50 · 109/L – 1U PLT

MA < 70 mm – 1U platelets

Fibrinogen < 0.0012 mg/L – fibrinogen 2 g

α-angle < 72° - fibrinogen 2 g

  1. Control group = groups managed without the use of either TEG or ROTEM. Intervention group = groups managed with the use of TEG or ROTEM. Htc haematocrit, Hb haemoglobin, PC platelet count, U units, PT prothrombin time, N/A not applicable, CCT conventional coagulation test, RBC red blood cell, FFP fresh frozen plasma, PLT platelets, INR international normalized ratio, ACT activated clotting time, MA maximal amplitude, TXA tranexamic acid, R reaction time, aPTT activated partial thromboplastin time, CPB cardiopulmonary bypass, hTEG heparinase-TEG, POC point of care