The Applicability of Thromboelastography in Acute Ischemic Stroke: A Literature Review

Pirlog, Bianca Oana; Grotta, James C.

doi:10.1055/s-0042-1753529

Cited by 6 publications

(9 citation statements)

References 56 publications

(119 reference statements)

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Section: Neurologic Critical Illnessmentioning

confidence: 99%

“…Patients with acute ischemic stroke (AIS) are hypercoagulable relative to healthy controls 21 . Studies have demonstrated associations between post‐AIS complications, stroke etiology, and VET parameters 21 . In a cohort of 246 AIS patients, a TEG R time <3.45 min predicted early neurologic deterioration with 87.9% sensitivity and 40.3% specificity 22 .…”

Section: Neurologic Critical Illnessmentioning

confidence: 99%

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The clot thickens: How to use viscoelastic testing in critical illness

Rech

Gilbert

Nei

et al. 2023

J Am Coll Clin Pharm

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Coagulopathy is common in critically ill patients and may result in complications such as bleeding or thromboembolic events. Viscoelastic testing (VET), including both thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®), offers a benefit over conventional coagulation tests in that it provides a qualitative and quantitative assessment of the degree of coagulopathy, including the ability to measure fibrinolysis. This review is a “how‐to” primer for critical care pharmacists to interpret and utilize VET in practice across a spectrum of coagulopathies, including trauma and traumatic brain injury, neurologic injury and emergencies, cardiothoracic surgery, liver disease, and medication‐induced coagulopathy.

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Section: Neurologic Critical Illnessmentioning

confidence: 99%

Section: Neurologic Critical Illnessmentioning

confidence: 99%

The clot thickens: How to use viscoelastic testing in critical illness

Rech

Gilbert

Nei

et al. 2023

J Am Coll Clin Pharm

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“…In addition to predicting the risk of hemorrhagic conversion, viscoelastic tests may also be helpful in identifying patients that have received anticoagulant therapy, specifically direct‐acting oral anticoagulants (DOACs) which are more difficult to detect with traditional anticoagulation tests. Prolonged R time has reliably detected anticoagulant effects of factor Xa inhibitor treatment and may be a helpful marker for deciding when to withhold thrombolytic therapy in AIS or when to initiate anticoagulant reversal therapy in acute hemorrhagic stroke 31 . Pharmacists have a primary role in this decision‐making.…”

Section: Ischemic and Hemorrhagic Strokementioning

confidence: 99%

Non‐trauma uses of viscoelastic hemostatic assays in critical care: A narrative review and primer for pharmacists

Smith

Barlow

et al. 2023

J Am Coll Clin Pharm

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Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are point‐of‐care viscoelastic tests of whole blood that provide real‐time analyses of coagulation. TEG and ROTEM are often used to guide blood product administration in the trauma and surgical settings. These tests are increasingly being explored for their use in other disease states encountered in critically ill patients and in the management of antithrombotic medications. As the medication experts, pharmacists should be familiar with how to interpret and apply viscoelastic tests to disease state and medication management. The purpose of this narrative review is to provide a primer for pharmacists on viscoelastic tests and their interpretation and to explore non‐trauma indications for viscoelastic testing in critical care. Literature evaluating the use of TEG and ROTEM for patients with acute and chronic liver disease, ischemic and hemorrhagic stroke, myocardial infarction, cardiac arrest, coronavirus disease 2019, and extracorporeal membrane oxygenation are described. Current applications of viscoelastic tests by pharmacists and potential future roles of critical care pharmacists in expanding the use of viscoelastic tests are summarized.

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mentioning

confidence: 99%

“…They are used in subarachnoid hemorrhage and intracranial hemorrhage 8 as well as in acute ischemic stroke. 9 In addition, these methods are used in the management of COVID-19 patients. 10,11 As its use becomes more popular, improvement in both the technique and knowledge of viscoelastography is indeed a challenge for continued and future research.…”

mentioning

confidence: 99%