Systemic Review on the Importance of Early Diagnosis and Monitoring of Treatment of Factor XIII Deficiency Among Polytraumatized Patients Using the ROTEM Method

One of the most important early causes of death among polytraumatized patients is represented by coagulopathy as a result of alteration of the coagulation pathway with a result that varies from harmful haemorrhagic diathesis to thrombosis. The poly-traumatized patient is characterized by acute posttraumatic coagulopathy resulted by the alteration of tissue integrity and hypo perfusion of peripheral tissues. Consumptive thrombocytopenia together with platelet dysfunction, coagulation factor deficiency, and hyperfibrinolysis, with iatrogenic treatment (massive transfusion, hypothermia, and excess volume repletion solutions) are part of the pathogenesis of posttraumatic coagulopathy. Because of the substantial impact of alteration of the fluid-coagulant status on therapeutic management, it is natural that an early diagnosis will help to improve medical care procedures. This is possible with the help of ROTEM (rotational thromboelastometry) which indicates the type of coagulopathy early on. This method provides information about clot formation, formation kinetics, clot firmness, and about the reverse process fibrinolysis through physical analysis methods of its viscoelastic property. It provides in-depth information compared to the "usual" coagulogram, as the ROTEM method targets the coagulation process as an assembly of the blood in its entirety. Following the review of the currently available data on mortality and morbidity of patients whose treatment plan was guided in real time by dynamic methods of assessing the coagulation status, it can be said that individualized therapy, applied based on successive data, had much better results in terms of the quality of health care, costs, and most importantly in the survival of patients with minimal side effects. Therefore, there is a strong recommendation to approach these tests from the emergency room units and as soon as the patient is admitted to intensive care.