Tracing the Lines: A Review of Viscoelastography for Emergency Medicine Clinicians

Gilbert, Brian W.; Bissell, Brittany D; Santiago, Ruben D.; Rech, Megan A.

doi:10.1016/j.jemermed.2020.04.009

Cited by 15 publications

(31 citation statements)

References 72 publications

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“…TEG ® and ROTEM ® have been extensively studied and applied in adult patients, especially in major bleeding related to severe trauma and surgical fields, such as liver transplantation as well as cardiac and obstetric procedures. Their use has been largely considered in the management of trauma-induced coagulopathy because of their great precision to identify the lacking element involved in the hemostasis reaction [ 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ].…”

Section: Viscoelastic Testing Results From Healthy Neonatesmentioning

confidence: 99%

TEG® and ROTEM® Traces: Clinical Applications of Viscoelastic Coagulation Monitoring in Neonatal Intensive Care Unit

et al. 2021

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The concentration of the majority of hemostatic proteins differs considerably in early life, especially in neonates compared to adulthood. Knowledge of the concept of developmental hemostasis is an essential prerequisite for the proper interpretation of conventional coagulation tests (CCT) and is critical to ensure the optimal diagnosis and treatment of hemorrhagic and thrombotic diseases in neonatal age. Viscoelastic tests (VETs) provide a point-of-care, real-time, global, and dynamic assessment of the mechanical properties of the coagulation system with the examination of both cellular and plasma protein contributions to the initiation, formation, and lysis of clots. In this work, we provide a narrative review of the basic principles of VETs and summarize current evidence regarding the two most studied point-of-care VETs, thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®), in the field of neonatal care. A literature analysis shows that viscoelastic hemostatic monitoring appears to be a useful additive technique to CCT, allowing targeted therapy to be delivered quickly. These tools may allow researchers to determine the neonatal coagulation profile and detect neonatal patients at risk for postoperative bleeding, coagulation abnormalities in neonatal sepsis, and other bleeding events in a timely manner, guiding transfusion therapies using the goal-oriented transfusion algorithm. However, diagnosis and treatment algorithms incorporating VETs for neonatal patients in a variety of clinical situations should be developed and applied to improve clinical outcomes. Further studies should be performed to make routinary diagnostic and therapeutic application possible for the neonatal population.

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Section: Viscoelastic Testing Results From Healthy Neonatesmentioning

confidence: 99%

TEG® and ROTEM® Traces: Clinical Applications of Viscoelastic Coagulation Monitoring in Neonatal Intensive Care Unit

et al. 2021

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“…In contrast to most of the studies that included patients in the acute or severe phase of the disease, the current study included patients at the physical examination center who were probably in stable condition. It should be noted that the blood coagulation condition of patients who have experienced or who are experiencing an acute ischemic stroke varied widely [ 25 ]. Furthermore, the small sample size and few CVD events in the present study reduce the statistical power.…”

Section: Discussionmentioning

confidence: 99%

Association Between Thromboelastography and Coronary Heart Disease

et al. 2022

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Background Thromboelastography (TEG) is a novel blood viscoelasticity detection method revealing blood coagulation status and has been reported to be helpful in predicting clinical outcomes in patients with cardiovascular diseases (CVD). In this study, we aimed to investigate the association between TEG and CVD. Material/Methods A single-center case-control study was performed. Individuals who took TEG tests at Tongji Hospital in Wuhan, China from 2015 to 2019 were included. The nearest-neighbor Mahalanobis matching with replacement, within propensity score calipers of 0.25 was used to control the covariate imbalance between CVD patients and controls. Logistic regression analyses were conducted to assess the relationship between TEG and CVD. Subgroup and sensitivity analyses were performed to evaluate the robustness of the association between TEG and CVD. Results After matching, a total of 151 participants were included in this study, with 83 patients having CVD (49 patients having coronary heart disease [CHD] and 34 patients having an ischemic stroke). By comparison, CHD patients had a significantly higher maximum amplitude (MA) ( P =0.02) than controls. After multivariable adjustment, MA (OR 1.11, 95% CI 1.01–1.24, P =0.04) was independently associated with CHD. The association between MA and CHD remained robust across subgroups and in sensitivity analyses. Conclusions The current study suggests that MA is significantly associated with CHD. Enhanced platelet reactivity as described by high MA might be associated with risk of CHD. The exact role of MA in the measurement of CHD risk needs to be further examined in large-scale prospective cohort studies.

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“…An additional tool that can be used to quantify the presence of coagulopathy is thromboelastography. 5 Our facility utilizes the TEG ® 5000 Thromboelastograph ® Hemostasis Analyzer System. This allows clinicians to identify coagulopathy via whole blood rather than through individual conventional testing.…”

Section: Discussionmentioning

confidence: 99%

“…Thromboelastography (TEG) can measure whole blood clot formation and breakdown and is ideal for critically ill patients. 5 Critically ill patients are already at an increased risk for VTE for numerous reasons, and COVID-19 potentiates that risk. 4,6 The importance of recognizing this risk is imperative to mitigating morbidity and mortality in these patients.…”

Section: Introductionmentioning

confidence: 99%

Successful Use of Aspirin, Apixaban, and Viscoelastography in a Patient with Severe COVID Disease and Allergy to Porcine Products

2021

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Coagulation abnormalities are frequently described in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Common thromboprophylaxis and anticoagulation treatment strategies include the use of heparinoid therapy. We describe a 57-year-old woman with an allergy to porcine products that was started on apixaban for anticoagulation therapy given her allergy profile and need for venous thromboembolism prophylaxis. Apixaban and aspirin therapy were optimized with the support of serial viscoelastography and platelet function assays. Our patient experienced respiratory failure requiring intubation for 7 days but was successfully weaned to room air, tolerated a regular diet, and ultimately discharged to home after a 17-day hospital course. Here we report the safe and successful use of aspirin, apixaban, and viscoelastography for COVID-19-associated coagulopathy.

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Tracing the Lines: A Review of Viscoelastography for Emergency Medicine Clinicians

Cited by 15 publications

References 72 publications

TEG® and ROTEM® Traces: Clinical Applications of Viscoelastic Coagulation Monitoring in Neonatal Intensive Care Unit

TEG® and ROTEM® Traces: Clinical Applications of Viscoelastic Coagulation Monitoring in Neonatal Intensive Care Unit

Association Between Thromboelastography and Coronary Heart Disease

Successful Use of Aspirin, Apixaban, and Viscoelastography in a Patient with Severe COVID Disease and Allergy to Porcine Products

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