Use of Thromboelastography in the Evaluation and Management of Patients With Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Abstract

Supplemental Digital Content is available in the text.

Viscoelastic Testing and Coagulopathy of Traumatic Brain Injury

“…Published in 2019, the 5th edition of the European guideline on management of major bleeding and coagulopathy following trauma changed their recommendations to include the use of VETs such as thromboelastography (TEG ® ) and rotational thromboelastometry (ROTEM ® ) for patients with systematic multiple trauma and with TBI [47]. There are many advantages in using VETs to detect CTBI [4,6,23,48,58]. For example, VETs provide real-time coagulation information on the presence of anticoagulation or antiplatelet medications and the patient's initial coagulation profile, allowing for the monitoring of therapeutic interventions such as hemostatic adjuncts or blood component transfusion [23,47,[58][59][60][61][62][63].…”

“…There are many advantages in using VETs to detect CTBI [4,6,23,48,58]. For example, VETs provide real-time coagulation information on the presence of anticoagulation or antiplatelet medications and the patient's initial coagulation profile, allowing for the monitoring of therapeutic interventions such as hemostatic adjuncts or blood component transfusion [23,47,[58][59][60][61][62][63]. Furthermore, modified TEG ® Platelet Mapping (TEG-PM ® ) and ROTEM ® with adjunctive multiple electrode aggregometry (MEA) can also be used to quickly determine platelet function abnormalities from inherent TBI coagulopathy or antiplatelet medications [23,39,58,[61][62][63][64][65][66][67].…”

“…These global hemostatic assays use a surrogate endpoint of maximum clot firmness and allow the evaluation of additional information on clotting kinetics, platelet-fibrin interactions, and fibrinolysis [69]. In addition, POC non-VET platelet function tests like Platelet Function Analyzer-100 (PFA-100), MEA (also known as Multiplate ® ), VerifyNow P2Y12, and the modified VET TEG-PM ® may assist in detecting platelet dysfunction [39,58,63,64,67,[70][71][72][73][74]. The degree of ADP-receptor inhibition has been suggested to correlate with the severity of TBI, described as a "dose-response relationship" between TBI severity and the degree of platelet dysfunction [64].…”

“…The degree of ADP-receptor inhibition has been suggested to correlate with the severity of TBI, described as a "dose-response relationship" between TBI severity and the degree of platelet dysfunction [64]. There may also be a role for platelet function assays in monitoring platelet dysfunction mediated by antiplatelet agents [23,52,58,61,64,66,67,74].…”

“…Observational and retrospective studies have shown some benefit when platelet transfusion is guided by TEG-PM ® and ROTEM ® with MEA, PFA, or VerifyNow P2Y12. This remains an area of significant research since the administration of platelets in these patients is now determined locally by institutional preferences with variable use of TEG-PM ® and ROTEM ® with adjunctive PFAs [23,39,58,74,[173][174][175].…”