TEG Platelet Mapping and Impedance Aggregometry to Predict Platelet Transfusion During Cardiopulmonary Bypass in Pediatric Patients

Barker, Erin; Saini, Arun; Gazit, Avihu Z.; Shea, Susan M.; Baltagi, Sirine; Gage, Brian F.; Spinella, Philip C.

doi:10.3389/fped.2019.00509

Cited by 14 publications

(6 citation statements)

References 16 publications

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“…Overall, hemorrhagic complications were associated with factor inactivity and inability to initiate clot formation (R > 8 min), whereas ischemic complications occurred with platelet hyperactivity (MA-AA/ADP > 50 mm). Others proceeded to DIC and death with extremes of TEG variables (R > 10 min or LY30 > 10%), including primary fibrinolysis, previously noted to carry a 70–100% mortality rate in critically injured patients ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

Integral Use of Thromboelastography With Platelet Mapping to Guide Appropriate Treatment, Avoid Complications, and Improve Survival of Patients With Coronavirus Disease 2019–Related Coagulopathy

Hranjec

Estreicher

Rogers³

et al. 2020

Critical Care Explorations

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Objectives: Coagulopathy of coronavirus disease 2019 is largely described as hypercoagulability, yet both thrombotic and hemorrhagic complications occur. Although therapeutic and prophylactic anticoagulant interventions have been recommended, empiric use of antifactor medications (heparin/enoxaparin) may result in hemorrhagic complications, including death. Furthermore, traditional (antifactor) anticoagulation does not address the impact of overactive platelets in coronavirus disease 2019. The primary aim was to evaluate if algorithm-guided thromboelastography with platelet mapping could better characterize an individual’s coronavirus disease 2019-relatedcoagulopathic state and, secondarily, improve outcomes. Design, Setting, and Patients: Coronavirus disease 2019 patients ( n = 100), receiving thromboelastography with platelet mapping assay upon admission to an 800-bed tertiary-care hospital, were followed prospectively by a hospital-based thromboelastography team. Treating clinicians were provided with the option of using a pre-established algorithm for anticoagulation, including follow-up thromboelastography with platelet mapping assays. Two groups evolved: 1) patients managed by thromboelastography with platelet mapping algorithm (algorithm-guided-thromboelastography); 2) those treated without thromboelastography with platelet mapping protocols (non-algorithm-guided). Outcomes included thrombotic/hemorrhagic complications, pulmonary failure, need for mechanical ventilation, acute kidney injury, dialysis requirement, and nonsurvival. Interventions: Standard-of-care therapy with or without algorithm-guided-thromboelastography support. Measurements and Main Results: Although d -dimer, C-reactive protein, and ferritin were elevated significantly in critically ill (nonsurvivors, acute kidney injury, pulmonary failure), they did not distinguish between coagulopathic and noncoagulopathic patients. Platelet hyperactivity (maximum amplitude-arachidonic acid/adenosine diphosphate > 50 min), with or without thrombocytosis, was associated with thrombotic/ischemic complications, whereas severe thrombocytopenia (platelet count < 100,000/μL) was uniformly fatal. Hemorrhagic complications were observed with decreased factor activity (reaction time > 8 min). Non-algorithm-guided patients had increased risk for subsequent mechanical ventilation (relative risk = 10.9; p < 0.0001), acute kidney injury (relative risk = 2.3; p = 0.0017), dialysis (relative risk = 7.8; p < 0.0001), and death (relative risk = 7.7; p < 0.0001), with 17 of 28 non-algorithm-guided patients (60.7%) dying versus four algorithm-guided-thromboelastography patients (5.6%) ( p < 0.0001). Thromboelastography with platelet mapping–guided antiplatelet treatment decreased m...

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Section: Discussionmentioning

confidence: 99%

Integral Use of Thromboelastography With Platelet Mapping to Guide Appropriate Treatment, Avoid Complications, and Improve Survival of Patients With Coronavirus Disease 2019–Related Coagulopathy

Hranjec

Estreicher

Rogers³

et al. 2020

Critical Care Explorations

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“…Their study was performed on healthy full-term and late preterm newborns, and platelet hyporesponsiveness was combined with hypercoagulation profiles modified by gestational age. An evaluation of clot formation, together with platelet function among adults and children transfused with platelets after a cardiopulmonary bypass, has recently been reported [ 79 ]. The discrepancy between MCF in the extrinsic (EXTEM) and fibrinogen (FIBTEM) pathway reaction times of ROTEM tests was recently used as an index for platelets’ contribution to clot strength [ 80 ].…”

Section: Viscoelastic Tests and Platelet Functionmentioning

confidence: 99%

Neonatal Sepsis and Hemostasis

et al. 2022

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Neonatal sepsis is considered critical for a significant increase in neonatal morbidity and mortality among hospitalized neonates. Neonatal sepsis, in most cases, coexists with coagulopathy, which can prove to be life-threatening. Complex molecular and cellular systems are involved in the cross-talk between inflammation and hemostasis during sepsis. Disturbances in the regulating systems of the vascular endothelium, and platelet–endothelial and platelet–neutrophil interactions play a pivotal role in both inflammation and coagulation. This complex process is poorly understood in neonates. In addition to the developmental maturation of hemostasis and the immune response in neonatal sepsis, a cellular model of hemostasis during sepsis should be taken into account. This review focused on the molecular and cellular mechanisms underlying inflammation and hemostasis during neonatal sepsis, taking the developmental immune response and developmental hemostasis into account in order to provide future diagnostic approaches to be applied in everyday clinical settings. Regarding the diagnostic modalities, we briefly provide the limitations of the currently used conventional coagulation assays, focusing on viscoelastic tests and platelet flow cytometry.

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“…Nevertheless, the authors reported an overlap in platelet receptor inhibition between the three examined groups of patients, which could, in their opinion, limit the clinical utility of the assay. Subsequently, several other studies reported that the use of TEG ® Platelet Mapping™ could predict postoperative blood loss among patients who underwent cardiac [ 53 , 54 , 55 , 56 , 57 , 58 , 59 ], trauma or other non-cardiac surgery [ 60 , 61 , 62 , 63 , 64 ] and received antiplatelet therapy.…”

Section: Viscoelastic Hemostatic Assays and Platelet Function Testmentioning

confidence: 99%

Viscoelastic Hemostatic Assays and Platelet Function Testing in Patients with Atherosclerotic Vascular Diseases

et al. 2021

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Platelets play crucial role in acute vascular atherosclerotic diseases, including myocardial infarction and stroke. Additionally, platelet aggregation is a key target of antiplatelet agents, forming the keystone of pharmacotherapy of various atherosclerotic cardiovascular diseases. Thromboelastography and thromboelastometry, representing currently available viscoelastic hemostatic assays (VHA), are designed as whole blood, real-time analyzers of clot formation and clot resolution. These assays could, in theory, overcome some limitations of currently available platelet function testing assays. This article reviews the current experience with the use of VHA for platelet function testing and for monitoring of the response to antiplatelet therapy.

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TEG Platelet Mapping and Impedance Aggregometry to Predict Platelet Transfusion During Cardiopulmonary Bypass in Pediatric Patients

Cited by 14 publications

References 16 publications

Integral Use of Thromboelastography With Platelet Mapping to Guide Appropriate Treatment, Avoid Complications, and Improve Survival of Patients With Coronavirus Disease 2019–Related Coagulopathy

Integral Use of Thromboelastography With Platelet Mapping to Guide Appropriate Treatment, Avoid Complications, and Improve Survival of Patients With Coronavirus Disease 2019–Related Coagulopathy

Neonatal Sepsis and Hemostasis

Viscoelastic Hemostatic Assays and Platelet Function Testing in Patients with Atherosclerotic Vascular Diseases

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