The Rapid TEG<b>α</b>-Angle May Be a Sensitive Predictor of Transfusion in Moderately Injured Blunt Trauma Patients

Jeger, Victor; Willi, Sandra; Liu, Tun; Yeh, D. Dante; Moya, Marc de; Zimmermann, Heinz; Exadaktylos, Aristomenis K.

doi:10.1100/2012/821794

Cited by 37 publications

(30 citation statements)

References 19 publications

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“…Therefore, tissue factor concentrations used in the two techniques may be different, potentially influencing their correlation. Our results, showing a significant correlation between INR and r-TEG parameters exploring thrombus generation and the enzymatic portion of coagulation, are in line with the findings of previous studies and with subgroup analysis on anticoagulated patients [14,15,27]. The correlation results suggest that there may be an association with a moderate correlation between INR and both ACT and r-R. Data on a larger sample of data points will be needed to establish the magnitude and clinical relevance of this potential association.…”

Section: Discussionsupporting

confidence: 91%

“…Both TEG and r-TEG have been tested in several studies and in different clinical settings in comparison to standard coagulation parameters, such as INR, PT, activated partial thromboplastin time (aPTT) and platelet count. While the correlation between TEG and standard coagulation test has been shown to be poor [25,26], a significant correlation has been demonstrated between INR and r-TEG parameters [14,15,27]. In a study on 76 patients with suspected multiple injuries evaluated with both TEG and r-TEG, no correlation was found between INR and R, while there was moderate correlation between individual r-TEG parameters and standard coagulation parameters, in particular between INR with r-R and ACT [27].…”

Section: Discussionmentioning

confidence: 98%

“…While the correlation between TEG and standard coagulation test has been shown to be poor [25,26], a significant correlation has been demonstrated between INR and r-TEG parameters [14,15,27]. In a study on 76 patients with suspected multiple injuries evaluated with both TEG and r-TEG, no correlation was found between INR and R, while there was moderate correlation between individual r-TEG parameters and standard coagulation parameters, in particular between INR with r-R and ACT [27]. Similar results were obtained by Cotton et al [15] in a study on 272 trauma patients, in whom ACT, r-K and r-R were shown to be strongly correlated with PT.…”

Section: Discussionmentioning

confidence: 99%

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Role of thromboelastography and rapid thromboelastography to assess the pharmacodynamic effects of vitamin K antagonists

Franchi

Hammad

Rollini

et al. 2014

J Thromb Thrombolysis

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Thromboelastography (TEG) measures the effects of antithrombotic agents by assessing global functional clotting status by evaluating the viscoelastic properties of in vitro clot formation. Recently, rapid TEG (r-TEG), which uses tissue factor in addition to standard kaolin to accelerate activation of the clotting cascade, has been proposed to obtain more immediate results. The correlation between results of TEG or r-TEG with international normalized ratio (INR) in patients on vitamin K antagonist (VKA) therapy has not been explored and represents the aim of this study. Patients on chronic therapy with VKAs (n = 100) were included in an observational prospective pharmacodynamic study. The correlation between TEG parameters, in particular markers of thrombus generation [Reaction time (R), maximum rate of thrombus generation (MRTG), and time to maximum rate of thrombus generation (TMRTG)], and INR values as well as the concordance between these parameters and therapeutic INR ranges were evaluated. In addition, in a subgroup of subjects (n = 17), the correlation of r-TEG parameters with TEG parameters and INR values was also assessed. No correlation was found between INR and TEG parameters of thrombus generation, in particular between INR and R (r = 0.189, p = 0.06), MRTG (r = -0.027, p = 0.79), and TMRTG (r = 0.188, p = 0.06). Further, no concordance was found between these parameters and recommended INR ranges. Significant Spearman correlations were found between INR and activated clotting time (rS = 0.546, p < 0.001), r-R (rS = 0.572, p = 0.017), and r-TMRTG (rS = 0.510, p = 0.037), but not r-MRTG (rS = 0.131, p = 0.617). Results were obtained in 24 ± 6 versus 12 ± 4 min with TEG and r-TEG, respectively (p < 0.001). In patients on chronic VKA therapy, TEG is not a useful tool to evaluate VKA anticoagulant effect, compared with standard INR measurements. However, r-TEG parameters of thrombus generation correlate with INR levels, suggesting a possible role of this assay for measuring more expeditiously anticoagulant treatment effects.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Role of thromboelastography and rapid thromboelastography to assess the pharmacodynamic effects of vitamin K antagonists

Franchi

Hammad

Rollini

et al. 2014

J Thromb Thrombolysis

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“…The RapidTEG™, therefore, assesses both the extrinsic and intrinsic coagulation pathways and is reported to be more sensitive and specific than standard coagulation tests in predicting transfusion requirement in trauma patients. 77 Lu and colleagues 78 recently investigated the clinical applicability of thrombelastography in adult liver transplant. Their data, obtained with the kaolin-activated TEG® and RapidTEG™ assays, showed that both the MA and α-angle parameters significantly correlated with fibrinogen concentration and platelet count, at baseline (time of skin incision) and 30 minutes after graft reperfusion.…”

Section: Limitations and Consequences Of Teg® Mono-analysis To Guide mentioning

confidence: 99%

Can the Viscoelastic Parameter α-Angle Distinguish Fibrinogen from Platelet Deficiency and Guide Fibrinogen Supplementation?

Solomon¹,

Schöchl²,

Ranucci

et al. 2015

Anesthesia &Amp; Analgesia

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Viscoelastic tests such as thrombelastography (TEG, Haemoscope Inc., Niles, IL) and thromboelastometry (ROTEM, Tem International GmbH, Munich, Germany), performed in whole blood, are increasingly used at the point-of-care to characterize coagulopathic states and guide hemostatic therapy. An algorithm, based on a mono-analysis (kaolin-activated assay) approach, was proposed in the TEG patent (issued in 2004) where the α-angle and the maximum amplitude parameters are used to guide fibrinogen supplementation and platelet administration, respectively. Although multiple assays for both the TEG and ROTEM devices are now available, algorithms based on TEG mono-analysis are still used in many institutions. In light of more recent findings, we discuss here the limitations and inaccuracies of the mono-analysis approach. Research shows that both α-angle and maximum amplitude parameters reflect the combined contribution of fibrinogen and platelets to clot strength. Therefore, although TEG mono-analysis is useful for identifying a coagulopathic state, it cannot be used to discriminate between fibrin/fibrinogen and/or platelet deficits, respectively. Conversely, the use of viscoelastic methods where 2 assays can be run simultaneously, one with platelet inhibitors and one without, can effectively allow for the identification of specific coagulopathic states, such as insufficient fibrin formation or an insufficient contribution of platelets to clot strength. Such information is critical for making the appropriate choice of hemostatic therapy.

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“…It has been found that thromboelastography was a more accurate indicator of blood product requirements than conventional coagulation tests, reduction in clot formation rate and strength were indicative of transfusion requirements in patients with penetrating trauma, and reduced maximum amplitude of the thromboelastographic trace was associated with more blood products transfused [78]. Jeger et al [79] found that thromboelastographic angle α may be a sensitive predictor of transfusion in moderately injured blunt trauma patients.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Thromboelastometry as a Predictor of Transfusion Requirements during Adult Living Donor Liver Transplantation

Fayed

Mourad

Yassen

et al. 2015

Transfus Med Hemother

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Background: The ability to predict transfusion requirements may improve perioperative bleeding management as an integral part of a patient blood management program. Therefore, the aim of our study was to evaluate preoperative thromboelastometry as a predictor of transfusion requirements for adult living donor liver transplant recipients. Methods: The correlation between preoperative thromboelastometry variables in 100 adult living donor liver transplant recipients and intraoperative blood transfusion requirements was examined by univariate and multivariate linear regression analysis. Thresholds of thromboelastometric parameters for prediction of packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, and cryoprecipitate transfusion requirements were determined with receiver operating characteristics analysis. The attending anesthetists were blinded to the preoperative thromboelastometric analysis. However, a thromboelastometry-guided transfusion algorithm with predefined trigger values was used intraoperatively. The transfusion triggers in this algorithm did not change during the study period. Results: Univariate analysis confirmed significant correlations between PRBCs, FFP, platelets or cryoprecipitate transfusion requirements and most thromboelastometric variables. Backward stepwise logistic regression indicated that EXTEM coagulation time (CT), maximum clot firmness (MCF) and INTEM CT, clot formation time (CFT) and MCF are independent predictors for PRBC transfusion. EXTEM CT, CFT and FIBTEM MCF are independent predictors for FFP transfusion. Only EXTEM and INTEM MCF were independent predictors of platelet transfusion. EXTEM CFT and MCF, INTEM CT, CFT and MCF as well as FIBTEM MCF are independent predictors for cryoprecipitate transfusion. Thromboelastometry-based regression equation accounted for 63% of PRBC, 83% of FFP, 61% of cryoprecipitate, and 44% of platelet transfusion requirements. Conclusion: Preoperative thromboelastometric analysis is helpful to predict transfusion requirements in adult living donor liver transplant recipients. This may allow for better preparation and less cross-matching prior to surgery. The findings of our study need to be re-validated in a second prospective patient population.

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The Rapid TEGα-Angle May Be a Sensitive Predictor of Transfusion in Moderately Injured Blunt Trauma Patients

Cited by 37 publications

References 19 publications

Role of thromboelastography and rapid thromboelastography to assess the pharmacodynamic effects of vitamin K antagonists

Role of thromboelastography and rapid thromboelastography to assess the pharmacodynamic effects of vitamin K antagonists

Can the Viscoelastic Parameter α-Angle Distinguish Fibrinogen from Platelet Deficiency and Guide Fibrinogen Supplementation?

Preoperative Thromboelastometry as a Predictor of Transfusion Requirements during Adult Living Donor Liver Transplantation

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