Thromboelastography: Current Applications, Future Directions

Abstract

<p style="text-align:justify;"> <span>Analyzing coagulability often hinges on patient surveillance using prothrombin time (PT) or international normalized ratio (INR) and activ<span>ated partial thromboplastin time (aPTT) to monitor the extrinsic and intrinsic coagulation pathways, respectively A more complete assessment, however, can often be obtained using thromboelastography (TEG), a coagulation assa</span>y t<span>hat evaluates the efficiency of clot formation, as well as the viscoelastic properties of the clot. Developed by Dr. Helmut Hart</span>ert in 1948 <span>at the</span> UniversityofHe<span>idelberg</span><span>, it provides information regarding hemostasis as a dynamic process</span></span><span> </span><span>[1</span><span>,</span><span>2]</span><span>. Here, the TEG tec</span><span>hnique wil<span>l be described, as we</span>ll as<span> its current applications and future directions for its use.</span></span><span></span> </p

Review of Thromboelastography in Neurocritical Care

“…Blood used for TEG PM must first be heparinized so that thrombin activation does not skew the results. Real-time changes that are seen in the TEG profile represent the strength and speed of clot formation, and allow assessment of which clotting factors are contributing appropriately or inappropriately, thereby informing targeted blood product delivery in the bleeding patient [4]. The common TEG variables are described below in Table 1.…”

“…TEG measures many components of hemostasis (cellular, humoral, and fibrinolysic), identifying both hypocoagulable and hypercoagulable states, thereby facilitating targeted transfusion strategies [1]. TEG has been extensively studied and is commonly used in trauma, liver transplant surgery, cardiac surgery, obstetrics, bedside extracorporeal membrane oxygenation (ECMO) management, diagnosis of hypercoagulable states, major surgeries, hemophilia, and monitoring of antiplatelet therapy [2][3][4]. Point of care (POC) coagulation monitoring with thromboelastometry, which is similar to TEG as described below, has been shown to reduce the transfusion rate as well as costs in liver transplantation, cardiovascular surgery, and trauma surgery [5][6][7].…”

Thromboelastography: A Practice Summary for Nurse Practitioners Treating Hemorrhage

“…The treatment for prolonged K value is therefore to administer fibrinogen. 18 An α <45° suggests a less vigorous association of fibrin with platelets. In this case, treatment begins much higher on the coagulation cascade, with the replacement of both fibrinogen and factor VIII.…”

Platelet Function Disorders in Adolescents with Heavy Menstrual Bleeding: Clinical Presentations, Laboratory Testing and Treatment Options

“…The assay has a number of modifications but essentially uses a small curvette that is slowly rotated to imitate sluggish venous blood flow. Using a thin wire, a clot begins to form between the probe and the side of the cuvette, and the strength and thickness of the clot is measured over time [14].…”