Thrombelastography Suggests Hypercoagulability in Patients with Renal Dysfunction and Intracerebral Hemorrhage

Meier, Kevin; Saenz, Daniel M.; Torres, Glenda; Cai, Chunyan; Rahbar, Mohammed; McDonald, M; Fraser, Stuart; Espino, Elena; Choi, H. Alex; Edwards, Nancy; Lee, Ki-Won; Grotta, James C.; Chang, Tiffany R.

doi:10.1016/j.jstrokecerebrovasdis.2017.12.026

Cited by 14 publications

(17 citation statements)

References 31 publications

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“…The role of platelets in increasing clot strength, and an associated increased risk of thrombotic complications has been previously described. 25,26 To our surprise 40% of our controls had short R time, which one would expect to also be a function of platelet activity. However, R time has not been proven to be associated with thrombotic complications in previous studies 8,9,12 and may not be a clinically useful parameter.…”

Section: Discussionmentioning

confidence: 73%

Microfluidics contrasted to thrombelastography: perplexities in defining hypercoagulability

Lawson

Moore

et al. 2018

Journal of Surgical Research

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Background: Elevated clot strength (maximum amplitude [MA]) measured by thrombelastography (TEG) is associated with thrombotic complications. However, it remains unclear how MA translates to thrombotic risks, as this measurement is independent of time, blood flow, and clot degradation. We hypothesize that under flow conditions, increased clot strength correlates to time-dependent measurements of coagulation and resistance to fibrinolysis. Materials and methods: Surgical patients at high risk of thrombotic complications were analyzed with TEG and total thrombus-formation analysis system (T-TAS). TEG hypercoagulability was defined as an r <10.2 min, angle >59, MA >66 or LY30 <0.2% (based off of healthy control data, n = 141). The T-TAS AR and PL chips were used to measure clotting at arterial shear rates. T-TAS measurements include occlusion start time, occlusion time (OT), occlusion speed (OSp), and total clot generation (area under the curve). These measurements were correlated to TEG indices (R time, angle, MA, and LY30). Both T-TAS and TEG assays were challenged with tissue plasminogen activator (t-PA) to assess clot resistance to fibrinolysis. Results: Thirty subjects were analyzed, including five controls. TEG-defined hypercoagulability by MA was detectedin52% of the inflammatory bowel disease/cancer patients; 0%was detected in the controls. There were no TEG measurements that significantly correlated with T-TAS AR and PL chip. However, in the presence of t-PA, T-TAS AR determined OSp to have an inverse relationship with TEG angle (−0.477, P = 0.012) and LY30 (−0.449, P = 0.019), and a positive correlation with R time (0.441 P = 0.021). In hypercoagulability determined by TEG MA, T-TAS PL had a significantly reduced OT (4:07 versus 6:27 min, P = 0.043). In hypercoagulability defined by TEG LY30, T-TAS PL had discordant findings, with a significantly prolonged OT (6:36 versus 4:30 min, P = 0.044) and a slower OSp (10.5 versus 19.0 kPa/min, P = 0.030). Conclusions: Microfluidic coagulation assessment with T-TAS has an overall poor correlation with most TEG measurements in a predominantly hypercoagulable patient population, except in the presence of t-PA. The one anticipated finding was an elevated MA having a shorter time to platelet-mediated microfluidic occlusion, supporting the role of platelets and hypercoagulability. However, hypercoagulability defined by LY30 had opposing results in which a low LY30 was associated with a longer PL time to occlusion and slower OSp. These discordant findings warrant ongoing investigation into the relationship between clot strength and fibrinolysis under different flow conditions.

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Section: Discussionmentioning

confidence: 73%

Microfluidics contrasted to thrombelastography: perplexities in defining hypercoagulability

Lawson

Moore

et al. 2018

Journal of Surgical Research

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“…Las alteraciones en la fuerza global del coágulo también estuvieron presentes re ejando que la unión plaquetaria a la brina formada sugiere estar normal o alterada en el sentido de hiperactivación-hiperagregabilidad plaquetarias. En la valoración global del trazado de TEG describimos el estado hipercoagulable como la alteración más frecuente, con resultados similares a los reportados por Holloway, Nunns y Meier [36][37][38]. La hiper brinolisis fue el hallazgo más infrecuente.…”

Section: Discussionunclassified

“…Otra posibilidad es que la hipercoagulabilidad y la mayor rmeza de coágulo, vistas en la TEG de sujetos urémicos, sea compensatoria a la disfunción de la interacción plaquetapared vascular [37,38], lo que se apoyaría en mecanismos como la hiper brinogenemia (ello explicaría la alta frecuencia del ángulo-α elevado encontrado) y la hiperagregabilidad plaquetaria.…”

Section: Discussionunclassified

Alteraciones tromboelastográficas en pacientes con urgencia dialítica

Serrano

Tamayo

2021

Rev. Colomb. Nefrol.

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Antecedentes: La enfermedad renal cursa con alteraciones de la hemostasia aumentando el riesgo de eventos trombóticos y hemorrágicos. Objetivo: Describir las anormalidades de la coagulación en pacientes con urgencia dialítica según tromboelastografía y pruebas convencionales. Materiales y métodos: Serie de casos de 60 pacientes adultos con urgencia dialítica. Se tomaron muestras de sangre previo al implante de catéter de hemodiálisis o de diálisis peritoneal, se procesaron para tromboelastografía y pruebas convencionales. Resultados: En la interpretación global del tromboelastograma se identificó estado hipercoagulable en 60% de los pacientes. En el análisis individual de parámetros del trazado se demostraron alteraciones en la fase enzimática con ángulo-alfa aumentado en el 61.7% y tiempo R acortado en el 58.3% de los casos, alteraciones en la fase celular con MA y G aumentados en cerca del 45% y alteraciones en la estabilidad con hiperfibrinolisis en el 18%. El aPTT estaba prolongado en 23.7%. Conclusiones: En la interpretación global de la tromboelastografía de pacientes con urgencia dialítica el hallazgo mas frecuente es el estado hipercoagulable. En el análisis individual se encontraron alteraciones en todas las fases de la coagulación, siendo la mas frecuente la formación acelerada del coágulo, seguida por aumento de la fuerza del mismo. La tromboelastografía debería ser considerada como una prueba enfocada en la cabecera del paciente para la valoración de la hemostasia en estos pacientes. Palabras clave: insuficiencia renal crónica; lesión renal aguda; uremia; diálisis renal; tromboelastografía; enfocada en la cabecera del paciente

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“…Maximum amplitude (MA): the maximum width of the tracing; it represents the maximum clot strength, reflecting the function of platelets, and is normally 50 to 70 mm. 19,23 A TEG standard chart is shown in Figure 1.…”

Section: Teg Protocols and Parametersmentioning

confidence: 99%

“…7,19,20 As an emerging technology, thromboelastography (TEG) can more accurately reflect the dynamic effects of procoagulants, natural anticoagulants, platelets, and the fibrinolytic pathway, and it may provide a more accurate estimate of underlying coagulopathy. 19,[21][22][23] The objective of this study was to explore the relationships between blood coagulation parameters and SSNHL pathogenesis and recovery via TEG.…”

mentioning

confidence: 99%

Coagulation States in Patients With Sudden Sensorineural Hearing Loss Evaluated by Thromboelastography

Zhou

Feng

et al. 2020

Otolaryngol.--head neck surg.

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Objective The state of coagulation is controversial in patients with sudden sensorineural hearing loss (SSNHL). We used thromboelastography (TEG) to explore the relationships between blood coagulation parameters and SSNHL pathogenesis and recovery. Study Design Prospective study. Setting Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University. Methods A total of 104 newly diagnosed patients with SSNHL and 29 matched healthy controls were recruited. Hearing assessments, TEG, and conventional coagulation tests (CCTs) were performed, followed by standard treatments and follow-up. Results The TEG parameters of patients with SSNHL were in the normal range, but the group exhibited a significantly prolonged kinetic time (K; P = .004) and a smaller angle ( P = .003) as compared with the controls. After grouping the patients with SSNHL according to audiograms and comparing them in pairs, we found that the differences were significant only when controls were compared with patients with low-frequency SSNHL (K, P = .023; angle, P = .04) and flat-type SSNHL (K, P = .017; angle, P = .014). Logistic regression analysis showed that neither TEG nor CCT parameters significantly affected hearing improvement after SSNHL treatment. Conclusions Although the K value and angle were significantly increased and significantly reduced, respectively, in the test group as compared with the control group, the state of coagulation in patients with SSNHL was still within the normal range. No CCT or TEG coagulation parameters (except the angle) differed significantly among patients in each group according to hearing recovery status, which suggested that the coagulation status does not determine the prognosis of patients with SSNHL.

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Thrombelastography Suggests Hypercoagulability in Patients with Renal Dysfunction and Intracerebral Hemorrhage

Cited by 14 publications

References 31 publications

Microfluidics contrasted to thrombelastography: perplexities in defining hypercoagulability

Microfluidics contrasted to thrombelastography: perplexities in defining hypercoagulability

Alteraciones tromboelastográficas en pacientes con urgencia dialítica

Coagulation States in Patients With Sudden Sensorineural Hearing Loss Evaluated by Thromboelastography

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