Fig. 5.
Patient admitted after a motor vehicle crash and cardiac arrest (different from the one described in the case section). Rotational thromboelastometry (ROTEMĀ®, Tem International GmbH, Munich, Germany) analysis (EXTEM) showed a typical pattern of hyperfibrinolysis with an important reduction in clot amplitude and an immediate breakdown of the clot. After addition of aprotinin (antifibrinolytic agent, APTEM), the clot improved and became stable. In parallel, the FIBTEM was completely flat indicating a severe fibrinogen deficiency. Coagulopathy was confirmed by standard biology (activated partial thrombin time, 122 s; prothrombin time, 24 s; International Normalized Ratio, 2.1; fibrinogen, 1.1 g/l). Normal values are indicated in brackets and dashed lines demonstrate the limits of a normal tracing. Clotting time (CT); clot formation time (CFT), A (clot amplitude) at 5 (A5), 10 (A10), 15 (A15), and 20 min (A20); maximum clot firmness (MCF).