Thromboelastography-Platelet Mapping Allows Safe and Earlier Urgent Coronary Artery Bypass Grafting

Rogers, Austin; Allman, Robert D.; Fang, Xiangming; Kindell, Linda C.; Nifong, L. Wiley; Degner, Benjamin C.; Akhter, Shahab A.

doi:10.1016/j.athoracsur.2021.07.068

Cited by 7 publications

(6 citation statements)

References 18 publications

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“…34 In a single center retrospective study, TEG ® platelet mapping, a measure of platelet aggregometry, was used in 221 patients undergoing non-emergent CABG compared to 232 control patients who underwent a CABG procedure but did not receive a P2Y12 inhibitor. 35 The threshold used for CABG readiness in this trial was less than 50%…”

Section: Cardiothoracic Surgerymentioning

confidence: 92%

“…Historically, in order to reduce risk of bleeding, guidelines recommended waiting 5 to 7 days after a P2Y12 antiplatelet agent load before proceeding to coronary artery bypass graft (CABG) surgery 34 . In a single center retrospective study, TEG® platelet mapping, a measure of platelet aggregometry, was used in 221 patients undergoing non‐emergent CABG compared to 232 control patients who underwent a CABG procedure but did not receive a P2Y12 inhibitor 35 . The threshold used for CABG readiness in this trial was less than 50% ADP inhibition from the P2Y12 on TEG platelet mapping.…”

Section: Cardiothoracic Surgerymentioning

confidence: 99%

“…Overall, 77% of patients pre-treated with a P2Y12 antiplatelet agent were able to undergo CABG sooner than the historical recommendation based on TEG platelet mapping with no difference in blood product utilization between groups. 35 VET presents a useful tool in the pre-operative phase of care to better understand bleeding risk prior to CTS and potentially reduce the time to surgery as well as institutional cost.…”

Section: Cardiothoracic Surgerymentioning

confidence: 99%

See 2 more Smart Citations

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: Cardiothoracic Surgerymentioning

confidence: 92%

Section: Cardiothoracic Surgerymentioning

confidence: 99%

Section: Cardiothoracic Surgerymentioning

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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“…Special reagents are needed to identify and monitor antiplatelet therapy (i.e., platelet mapping) using thrombelastography or sonorheometry. 114…”

Section: Methodsmentioning

confidence: 99%

Classic Light Transmission Platelet Aggregometry: Do We Still Need it?

Gebetsberger,

Prüller

2023

Hamostaseologie

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For more than 50 years, light transmission aggregometry has been accepted as the gold standard test for diagnosing inherited platelet disorders in platelet-rich plasma, although there are other functional approaches performed in whole blood. In this article, several advantages and disadvantages of this technique over other laboratory approaches are discussed in the view of recent guidelines, and the necessity of functional assays, such as light transmission aggregometry in the era of molecular genetic testing, is highlighted.

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“…Also, they could predict thrombotic events [ 97 , 121 ] and even pump thrombosis risk [ 122 ]. They detected also the P2Y12 inhibition nonresponse, allowing earlier intervention for patients receiving preoperative inhibition therapy in 453 US vascular patients [ 123 ]. In comparison to conventional indicators, TEG parameters were better at predicting bleeding and clotting complications [ 124 ].…”

Section: Reviewmentioning

confidence: 99%

Thromboelastography in the Perioperative Period: A Literature Review

Ramanujam¹,

DiMaria²,

Varma³

2023

Cureus

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Assessing coagulation status is essential for prompt intervention to reduce morbidity and mortality related to bleeding and thrombotic complications during the perioperative period. Traditional coagulation tests such as platelet count, activated partial thromboplastin time (aPTT), prothrombin time (PT), international normalized ratio (INR), and activated clotting time (ACT) provide only static evaluation. These tests are not designed for assessment of dynamically changing coagulation conditions during the perioperative time. However, viscoelastic coagulation testing such as thromboelastography (TEG) produces a rapid numerical and graphical representation that helps to detect and direct targeted hemostatic therapy. Searching the literature through PubMed, Medline, Ovid, CINAHL, and ClinicalTrials.gov we retrieved 210 studies, which represent the use of TEG in the perioperative period. The included studies were categorized under various settings such as trauma, obstetrics, orthopedics, intensive care unit (ICU), cardiovascular, transplant, and miscellaneous scenarios. TEG showed promising results in trauma surgeries in predicting mortality, hypercoagulability, and bleeding even when it was compared to conventional methods. TEG was also useful in monitoring anticoagulant therapy in orthopedic and obstetric surgeries; however, its role in predicting thrombotic events, hypercoagulability, or complications was questionable. In ICU patients, it showed promising results, especially in the prediction or improvement of sepsis, coagulopathy, thrombotic events, ICU duration, hospital stay, and ventilator duration. TEG parameters effectively predicted hypercoagulation in transplant surgeries. Regarding cardiovascular surgeries, they were effective in the prediction of the need for blood products, coagulopathy, thrombotic events, and monitoring anticoagulation therapy. More randomized clinical trials comparing TEG parameters with standardized tools are needed to produce robust results to standardize its use in different perioperative settings.

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Thromboelastography-Platelet Mapping Allows Safe and Earlier Urgent Coronary Artery Bypass Grafting

Cited by 7 publications

References 18 publications

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

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

Classic Light Transmission Platelet Aggregometry: Do We Still Need it?

Thromboelastography in the Perioperative Period: A Literature Review

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