APTEM Testing for Guiding Antifibrinolytic Therapy in Hyperfibrinolysis

Introduction to APTEM Testing and Antifibrinolytic Therapy

• The American College of Critical Care recommends using APTEM testing to guide antifibrinolytic therapy in patients with suspected hyperfibrinolysis, with administration of tranexamic acid (10-15 mg/kg followed by 1-5 mg/kg/hour infusion) only when hyperfibrinolysis is confirmed by thromboelastometric monitoring 1, 2

Antifibrinolytic Therapy Protocol

• The Critical Care society recommends tranexamic acid: 10-15 mg/kg loading dose followed by 1-5 mg/kg/hour infusion for antifibrinolytic therapy when hyperfibrinolysis is confirmed by APTEM testing 1, 2, 3
• An alternative antifibrinolytic therapy includes ε-aminocaproic acid 100-150 mg/kg followed by 15 mg/kg/hour 1, 2

Cautions and Contraindications

• The Journal of Thrombosis and Haemostasis society advises that antifibrinolytic agents should not be used routinely without confirmed hyperfibrinolysis 4, 5, 6
• The Journal of Thrombosis and Haemostasis society recommends against routine use of antifibrinolytic agents in cancer-related DIC due to potential thrombotic risks 4, 5, 6

Special Considerations

• The Journal of Thrombosis and Haemostasis society suggests considering tranexamic acid only if therapy-resistant bleeding dominates the clinical picture in cancer-related DIC 4, 5, 6

Pharmacokinetic Considerations

• Tranexamic acid has a plasma half-life of approximately 120 minutes, and a plasma concentration of 10 μg/ml is required to inhibit fibrinolysis 1, 2, 3

Monitoring Therapy Effectiveness

• The Critical Care society recommends continuing APTEM monitoring during treatment to assess response, and discontinuing antifibrinolytic therapy once bleeding is controlled 1, 2