Klaus Gorlinger: TEM-guided POC Coagulopathy Management

Dr. Klaus Gorlinger is one of the leading international experts in the management of coagulopathy and has dedicated his career to perfecting the art & science of hemostatic resuscitation.  One of his major fields of expertise is the use of Point of Care (POC) guided algorithms for goal directed coagulopathy management.  Dr. Gorlinger is now the medical director of TEM international based out of Munich, Germany.  We were honored to have Dr. Gorlinger visit the city of Baltimore after the Consensus Conference on Thromboelastometry Based Transfusion Guidelines for Early Trauma Resuscitation in Philadelphia this past September.

This lecture is just a sneak preview at how the thought leaders in coagulopathy management are changing the landscape of resuscitation.

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Conventional vs. Point-of-care (POC)

• Conventional coagulation tests are static, and can have up to a 60 minute turn around time
• Bedside ROTEM (thromboelastometry) can give dynamic/functional coagulopathy diagnostics in as quick as 10 minutes

• ROTEM has a number of different coagulation tests to isolate individual targets of coagulopathy management
  • Extrinsic pathway (EXTEM)
  • Intrinsic pathway (INTEM)
  • Fibrin clotting function (FIBTEM)
  • Heparin effect (HEPTEM)
  • Fibrinolysis (APTEM)
  • *Direct thrombin inhibitor (DTI) effect (ECATEM)

Abnormal TEM Tracings, Interventions

TEM-Driven Coagulopathy Management Algorithm

Pearl:  Platelet count/function and fibrinogen level will significantly impact clinical bleeding, the critical A10 is 45 mm, but you can get there many different ways!

 Ok, so Dr. Gorlinger takes a nice shot at massive transfusion, brute force coagulopathy management, and America (kidding!)… but is this the future of mainstream coagulopathy management?  I’d love to hear what you all think, please leave your comments below!