Seamless Casualty Care - Coagulation Diagnostic - What do we need?

Coagulation diagnostic procedures are very helpful for the differential diagnosis of coagulation disorders such as dilution coagulopathy or hyperfibrinolysis in casualties. The classical methods (Platelet Count, Prothrombin Time (PT), Activated Partial Thrombin Time (APTT) and Fibrinogen) could be performed within 30 minutes, but often especially PT and APTT, do not correlate well with the clinical picture. This is caused by the failure to determine clot stability, platelet function and fibrinolysis. The ROTEM(R) is an improved version of the classical thrombelastograph and can be used at the point of care. After 10 to 15 minutes it provides an overview over factor deficiencies due to dilution, fibrinolysis, clot stability and the effect of thrombin inhibitors such as unfractioned heparin. But the lack of information about vasopathy, the ability of platelets to bind to collagen and the influence of acetylsalicylic acid remains. Because the ROTEM(R) system can be used at the point of care, trained staff is needed here. Finally we also consider for an overall diagnosis cooperation with a competence centre for coagulation diagnostical procedures and treatment.