Among the concerns pointed out in the literature are the effect of age [34–37], gender [38], use of citrated blood sample [39], sampling site, stability and repeated sampling [40–43] on the results observed. A number of activators and inhibitors are commonly used resulting in varied specificity of the assay [44]. Different

methods of data analysis have also been suggested [45]. In an interesting article Jackson et al “road tested” both TEG® and ROTEM® and summarized their finding regarding technical features, costs and pooled the opinion of the direct users [12]. The reproducibility of both TEG® and ROTEM® measurements has been reported as acceptable [46]. A recent systematic review of randomized clinical trials comparing TEG®- or ROTEM®-based Capmatinib order algorithms with standard treatment in non-trauma bleeding patients found that see more the current evidence supporting viscoelastic tests is weak [4]. This systematic review found only 9 randomized controlled

trials, 8 in cardiac surgery and 1 in liver transplantation. Possibly the greatest contribution of the viscoelastic tests is in the detection of hyperfibrinolysis, which no other test can diagnose as expeditiously. Interestingly, Nielsen pointed out in his study that TEG® and ROTEM® could potentially generate similar data, provided similar activators were utilized in both devices. This observation highlights the need for 4-Aminobutyrate aminotransferase standardization if the tests are to be comparable. Meanwhile, caution must be exercised in utilizing treatment algorithms based on one system while analyzing patient samples from the other, or even the same system but using different activators. In conclusion, TEG® and ROTEM® have many of the characteristics of ideal tests for use in trauma including global evaluation of coagulation, both quantitative and functional assessment, in vitro assays performed under conditions of ”no flow”. Their potential clinical utility must be balanced

against limitations particularly the considerable heterogeneity in methods, reagents and parameters evaluated. The present literature review suggests that in trauma TEG® and ROTEM® are not fully equivalent tests with interchangeable results and interpretations but as pointed out by Nielsen, this could be the results of using different activators (methods). The similarities identified were limited to TEG® MA and ROTEM® MCF measurements and their association with platelet counts and PTT. Other similarities were between TEG® CL and ROTEM® ML in check details diagnosing excessive fibrinolysis and mortality and TEG® MA and ROTEM® MCF association with blood transfusion and mortality. Despite their limitations, both tests are attractive and potentially useful as means to rapidly diagnose coagulopathy, guide transfusion and determine outcome of adult trauma patients.