LAUSR

Referring to an investigation in patients undergoing splenectomy, Mallett et al. defend the viewpoint that ROTEM tests is more contributive than thrombin generation tests. In our study, we exclusively included patients with cirrhosis. The thrombin generation test is an internationally recognised research tool which, contrary to the ROTEM system, has been validated by the International Society on Thrombosis and Haemostasis. Importantly, overall coagulation is not anymore restricted to the concept of separate extrinsic and intrinsic coagulation pathways on which are based ROTEM analyses. Also, ROTEM analysis accounts only for the conversion of fibrinogen to fibrin at the very early phase of thrombin formation, when more than 95% of total thrombin has not yet been generated. Additionally, the thrombin generation test in the presence of thrombomodulin monitors all generated thrombin which is regarded as the controlling enzyme of coagulation. Finally, in clinical investigations, the thrombin generation test detects all congenital or acquired alterations of coagulation. These situations are beyond the scope of the ROTEM analyses.