TEGROTEM

TEGROTEM is an umbrella term used to refer to thromboelastography and rotational thromboelastometry, point-of-care tests that assess coagulation by measuring the viscoelastic properties of whole blood as it clots. The technique provides a dynamic view of clot initiation, formation, strengthening, and dissolution, reflecting contributions from both cellular and plasma components of hemostasis. The assay is performed by placing a blood sample in a cup with a clot activator; during the test, either the cup or the sensor is rotated, and the evolving viscoelastic strength of the clot is recorded as a graphical trace and numerical parameters.

Common parameters include clotting time or reaction time (R or CT), the time to a defined clot firmness (K or CFT), the rate of clot formation indicated by the alpha angle, and the maximum clot strength (MA or MCF). Some systems also report lysis indices such as LY30 or LI30. Panels such as EXTEM (extrinsic pathway), INTEM (intrinsic pathway), FIBTEM (fibrin-based clot), and APTEM (aprotinin to test for fibrinolysis) are used to parse the contributions of platelets, fibrinogen, and fibrinolysis to the overall clot.

In clinical practice, TEG/ROTEM is used to guide transfusion and hemostatic therapy in settings such as cardiac surgery, liver transplantation, obstetric hemorrhage, trauma, and other major surgeries where rapid coagulation assessment is critical. They can detect hyperfibrinolysis and fibrinogen deficiency and help tailor products like platelets, cryoprecipitate, or fibrinogen concentrates.

Limitations include the need for trained operators, variability among devices and reagents, and limited direct interchangeability with standard coagulation tests. Pre-analytical factors and timing influence results, so interpretation should be integrated with clinical context.