Rapid thrombelastography (r-TEG) identifies hypercoagulability and predicts thromboembolic events in surgical patients

Kashuk, Jeffry L.; Moore, Ernest E.; Sabel, Allison; Barnett, Carlton C.; Haenel, James B.; Le, Tuan; Pezold, Michael; Lawrence, Jerry; Biffl, Walter L.; Cothren, Clay C.; Johnson, Jeffrey L.

doi:10.1016/j.surg.2009.06.054

Cited by 198 publications

(208 citation statements)

References 41 publications

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“…The trend toward a hypercoagulatory disposition and toward an increased risk of venous thromboembolism in the postoperative period after major surgery has been demonstrated in several studies. 17,18 This state can have manifold causes, such as tissue factor release due to surgical trauma, impaired fibrinolysis, or inflammation.…”

Section: Discussionmentioning

confidence: 99%

The Prevalence and Clinical Relevance of ASA Nonresponse After Cardiac Surgery: A Prospective Bicentric Study

Wand

Adam

Wetz

et al. 2017

Clin Appl Thromb Hemost

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We aimed to identify the prevalence of acetylsalicylic acid (ASA) nonresponse in patients after coronary artery bypass graft (CABG) surgery and the possible consequences for the rate of major cardiovascular events. This prospective, observational, bicentric cohort study was conducted in two German University hospitals. A total of 400 patients (200 in each study center) undergoing elective CABG surgery were enrolled after written informed consent. Platelet function was analyzed on day 3 (d3) and day 5 (d5) postoperatively following stimulation with arachidonic acid (ASPItest) and with thrombin receptor-activating peptide 6 (TRAPtest) using multiple electrode aggregometry (Multiplate). Individuals with an ASPItest !40 AUÁmin were categorized as ASA nonresponders. A 1-year follow-up recorded the combined end point of cardiovascular events, hospital admissions, or deaths related to cardiovascular disease. The prevalence of ASA nonresponse was 51.5% on d3, and it significantly increased to 71.3% on d5 (P ¼ .0049). The area under the aggregation curve in the TRAPtest (P < .0001), the platelet count on d5 (P ¼ .009), and the cardiopulmonary bypass time (P ¼ .01) were identified as independent predictors of an ASA nonresponse. A 1-year follow-up recorded 54 events fulfilling criteria for the combined end point with no difference between ASA responders and nonresponders. This study indicates a high incidence of perioperative ASA nonresponse in patients following CABG. No effect on the incidence of cardiovascular events was recorded in the 1-year follow-up. Therefore, a randomized dosage adjustment trial should elucidate whether a tailored ASA treatment after CABG surgery represents a useful concept.

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Section: Discussionmentioning

confidence: 99%

The Prevalence and Clinical Relevance of ASA Nonresponse After Cardiac Surgery: A Prospective Bicentric Study

Wand

Adam

Wetz

et al. 2017

Clin Appl Thromb Hemost

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“…It is uncertain whether TEG is sufficiently sensitive to detect subtle differences in the degree of maternal hypercoagulability. Although previous non-obstetric ); Non-AMA = no advanced maternal age (B 35 yr); r = reaction time; k = clot formation time; MA = maximum amplitude; G = shear modulus elastic strength; CL30 = clot lysis at 30 min after MA; MRTG = maximal rate of thrombus generation; TMRTG = time to maximum rate of thrombus generation; TTG = thrombus generation * n = 22 (1 analyzer error) n = 21 (2 analyzer errors) à n = 20 (1 patient refusal; 2 patients discharged before 72 hr) § n = 17 (1 patient discharged before 72 hr; 4 patients prescribed nonsteroidal anti-inflammatory drugs, and one patient prescribed enoxaparin at 72 hr) || P \ 0.05 for pre-Cesarean thromboelastography (TEG) variable vs 24 hr post-Cesarean TEG variable ** P \ 0.05 for 24 hr post-Cesarean TEG variable vs 72 hr post-Cesarean TEG variable studies have used TEG to detect a hypercoagulable state associated with venous thrombosis, [13][14][15] future populationwide studies incorporating more sensitive techniques are needed for a full evaluation of the potential associations between thrombin generation and platelet reactivity with postpartum VTE.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Furthermore, previous non-obstetric studies have reported that hypercoagulable states detected by TEG are associated with an increased risk of thrombotic complications, including myocardial infarction and thromboembolic events. [13][14][15] Nevertheless, these technologies have not been used to investigate whether differences exist in the maternal coagulation profile of AMA vs non-AMA women during the peripartum period.…”

Section: Résumémentioning

confidence: 99%

Impact de l’âge maternel avancé sur les profils de coagulation thrombo-élastographique du péripatum: une étude observationnelle prospective exploratoire

Butwick

Gutiérrez

Hilton

2014

Can J Anesth/J Can Anesth

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Purpose Advanced maternal age (AMA) is a known risk factor for pregnancy-related venous thromboembolism. However, it is unclear if underlying differences exist in the maternal coagulation profiles of AMA vs non-AMA women. The aim of this prospective observational study was to compare peripartum thromboelastography parameters of AMA and non-AMA women undergoing elective Cesarean delivery (CD). [25][26][27][28][29][30][31][32][33][34] yr in the AMA and non-AMA groups, respectively (P \ 0.001). We observed no statistically significant effect of study group on any thromboelastographic or laboratory coagulation parameters. No statistically significant correlations were found between any thromboelastographic parameter and maternal age. Peripartum thromboelastography and coagulation profiles of healthy AMA and healthy non-AMA women up to 72 hr post-CD were also similar. Conclusion These data suggest that maternal thromboelastographic profiles of healthy AMA and non-AMA women undergoing elective CD are similar. The study was registered at ClinicalTrials.gov (identifier: NCT01416454). Methods

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“…Разнородность данных не позволи-ла провести метаанализ. Несколько более поздних работ подтверждают предсказательную силу параметра максимальной амплитуды (МА): МА либо G (жест-кость сгустка = 5,000 MA / 100 -MA) у пациентов по-сле операций является независимым фактором риска повторного ишемического инсульта (ОШ 1,192; p = 0,022) [49], а также других тромботических осложне-ний, в том числе инфаркта миокарда [50,51]. Подоб-ные данные имеются для аналога ТЭГ -ROTEM [47].…”

Section: O N C O G E M a T O L O G Y 3 ' 2 0 1 5 V O L 10unclassified

Integrated laboratory coagulation tests in hypercoagulation diagnosis and thrombosis risk assessment. Part II. The sensitivity of integral tests to hypercoagulable states

Lipets¹,

Ataullakhanov²,

Panteleev³

2015

Onkogematologiâ

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Rapid thrombelastography (r-TEG) identifies hypercoagulability and predicts thromboembolic events in surgical patients

Cited by 198 publications

References 41 publications

The Prevalence and Clinical Relevance of ASA Nonresponse After Cardiac Surgery: A Prospective Bicentric Study

The Prevalence and Clinical Relevance of ASA Nonresponse After Cardiac Surgery: A Prospective Bicentric Study

Impact de l’âge maternel avancé sur les profils de coagulation thrombo-élastographique du péripatum: une étude observationnelle prospective exploratoire

Integrated laboratory coagulation tests in hypercoagulation diagnosis and thrombosis risk assessment. Part II. The sensitivity of integral tests to hypercoagulable states

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