Management of a postpartum coagulopathy using thrombelastography

Sharma, Shiv K.; Vera, Richard L.; Stegall, William C.; Whitten, Charles W.

doi:10.1016/s0952-8180(97)00026-3

Cited by 40 publications

(29 citation statements)

References 8 publications

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“…They have been used to demonstrate the hypercoagulable state of pregnancy [27][28][29] and the resolution to nonpregnant values in the puerperium. 30,31 There are numerous case reports of the use of TEG and ROTEM to guide replacement of blood components in the management of PPH 32,33 and studies have confirmed a reduction in blood loss and associated transfusion of blood products with the use of these tests in other settings. [34][35][36] A Cochrane systematic review of 9 randomized controlled trials (RCTs) (involving 776 bleeding patients) concluded that TEG or ROTEM significantly reduced blood loss, but there was no impact on mortality, amount of blood transfused, or length of stay in hospital and intensive care units.…”

Section: Point-of-care Testsmentioning

confidence: 99%

How I treat postpartum hemorrhage

Pavord

Maybury

2015

Blood

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Worldwide, ∼800 women die every day from preventable causes related to pregnancy or childbirth. The single most common cause is severe bleeding, which can kill a healthy woman within hours if care is substandard or delayed. Improved antenatal practices have led to the early identification of at-risk women and modern technology and new techniques have enabled effective management strategies so that now, in the western world, most of the morbidity and mortality arises from those cases which occur unexpectedly and could not have been predicted. Prompt and effective management and multidisciplinary involvement is paramount to save the lives of these women. We use a case report to illustrate and discuss the main elements of management of this condition.

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Section: Point-of-care Testsmentioning

confidence: 99%

How I treat postpartum hemorrhage

Pavord

Maybury

2015

Blood

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“…5,6 The theoretical advantage of TEG, over the standard monitors of coagulation (including: prothrombin time; activated, partial thromboplastin time; fibrinogen level; and platelet count), is that TEG uses whole blood to provide information on the entire clotting process (including: initiation and speed of clot formation; clot strength; and fibrinolysis).…”

Section: Reports Of Original Investigationsmentioning

confidence: 99%

Technical report: Analysis of citrated blood with thromboelastography: comparison with fresh blood samples

Wąsowicz

Srinivas

Meineri

et al. 2008

Can J Anesth/J Can Anesth

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Purpose: Thromboelastography (TEG) evaluates the viscoelastic properties of whole blood to assess clot formation and hemostasis. When blood cannot be analyzed immediately, it is stored in citrated tubes to be analyzed after recalcification. In this study, we evaluated the results of TEG analysis performed on citrated blood and compared these results to values obtained from activated (kaolin and tissue factor) and non activated, fresh blood samples, obtained at various time intervals (one, two, and three hours). Methods: Four blood samples were collected from each of ten healthy volunteers. The following TEG analyses were performed on each sample: reaction time (r), k time (k), alpha angle (α), and maximum amplitude (MA). Studies were done using fresh, non citrated blood, obtained within five minutes of collection, and using citrated blood, one, two, and three hours after collection. Samples were analyzed, with and without activation, using kaolin and tissue factor. Results:Tissue factor activated and non activated, citrated samples had shorter r and k times (P = 0.03, P = 0.008, P < 0.0001, and P < 0.0001, respectively) and higher alpha angle and MA values (P < 0.0001, P < 0.0001, P = 0.79, and P = 0.03, respectively) compared to fresh, non citrated samples. These findings were consistent with a hypercoagulable state. Conversely, citrated samples, activated with kaolin, yielded results similar to those obtained from fresh, non citrated samples. The TEG measurements were similar among citrated samples stored from one to three hours. Conclusions:Our results demonstrate that TEG measures, performed on citrated blood samples, yield results that are consistent with a hyperocoagulable state. Using kaolin to activate citrated samples, on the other hand, yields results similar to those obtained from non citrated, fresh blood samples.

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“…2a and b) [9]. Any HIT patient with abnormal TEG parameters should be considered for further evaluation and proper treatment before the establishment of irreversible thrombotic complications [10]. In our case, the interpretation of TEG results revealed platelet and enzymatic hypercoagulability demanding aggressive treatment with a direct thrombin inhibitor ( Fig.…”

Section: Discussionmentioning

confidence: 77%

Can thromboelastography predict which patients with heparin-induced thrombocytopenia may suffer thrombotic complications of type II?

Kouerinis

El-Ali

Theakos

et al. 2007

European Journal of Cardio-Thoracic Surgery

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Despite the existence of several sensitive functional and antigen assays used for the diagnosis of heparin-induced thrombocytopenia (HIT), an additional assessment of the patient's hemostatic status, in order to predict the thrombotic complications of the malevolent HIT type II, has become necessary. Herein below, we present the findings of thromboelastography (TEG) in a post-cardiac-surgery patient with the clinical diagnosis of HIT type II and false negative tests for heparin antibodies. We have reached the conclusion that TEG may prove to be a useful supplementary method to predict those HIT patients who may suffer complications of HIT type II.

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Management of a postpartum coagulopathy using thrombelastography

Cited by 40 publications

References 8 publications

How I treat postpartum hemorrhage

How I treat postpartum hemorrhage

Technical report: Analysis of citrated blood with thromboelastography: comparison with fresh blood samples

Can thromboelastography predict which patients with heparin-induced thrombocytopenia may suffer thrombotic complications of type II?

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