Use of thromboelastography to guide thromboprophylaxis after caesarean section

Boyce, H.; Hume-Smith, Helen; Ng, JM; Columb, Malachy O.; Stocks, G.M.

doi:10.1016/j.ijoa.2011.03.006

Cited by 15 publications

(18 citation statements)

References 26 publications

(33 reference statements)

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“…Of the 33 patients who had post‐enoxaparin TEG samples, only 17 (52%) showed this effect, although 24 (73%) were hypocoagulable compared to their pre‐operative samples, with increased R times, decreased MA and decreased CI values. A recent study found that the majority of patients given 7500 IU subcutaneous unfractionated heparin immediately before elective caesarean section remained hypercoagulable compared to pre‐operative samples [19]. These findings suggest that 40 mg enoxaparin has a greater anticoagulant effect than 7500 IU unfractionated heparin, an observation that has been made previously [20].…”

Section: Discussionmentioning

confidence: 69%

“…A heparin effect has been defined as a TEG R time > 25% longer than the heparinase‐corrected control [18, 19]. Of the 33 patients who had post‐enoxaparin TEG samples, only 17 (52%) showed this effect, although 24 (73%) were hypocoagulable compared to their pre‐operative samples, with increased R times, decreased MA and decreased CI values.…”

Section: Discussionmentioning

confidence: 99%

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Reference ranges for thromboelastography (TEG^®) and traditional coagulation tests in term parturients undergoing caesarean section under spinal anaesthesia*

Macafee¹,

Campbell²,

Ashpole

et al. 2012

Anaesthesia

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SummaryThere has been little published work defining 'normal' thromboelastography (TEG Ò ) values in healthy parturients, and few large studies defining reference ranges for traditional coagulation tests in this patient group. Our aim was to establish peri-operative reference ranges for TEG and for standard laboratory coagulation tests in our pregnant population. Fifty healthy term parturients presenting for elective caesarean section under spinal anaesthesia had blood samples taken pre-operatively, on arrival in the recovery room and, in a subset of 33 women, 4 h after routine thromboprophylaxis with enoxaparin 40 mg. All three samples had TEG analysis, the first and second having standard laboratory coagulation tests in addition. Reference ranges for our pregnant population were established, demonstrating a hypercoagulable state in term parturients and a significant effect of enoxaparin. The standard coagulation reference ranges were within 98% of the local non-pregnant ranges. These reference ranges provide a useful comparator for peri-operative TEG and routine coagulation analysis in term parturients. Accepted: 26 January 2012The recent decline in direct maternal deaths in the UK has been attributed largely to reductions in deaths due to thromboembolism, and, to a lesser extent, haemorrhage [1]. With increased awareness and more widespread use of thromboprophylaxis, and the ever-present risk of maternal haemorrhage, greater importance is being placed on the assessment of coagulation status and blood product replacement during the peripartum period.Thromboelastography (TEG Ò ) is a relatively new near-patient monitor of coagulation in UK labour wards, although its use in cardiac and liver surgery is long-standing [2,3]. The TEG evaluates the mechanical strength of clot during its formation, via the torsion in a pin suspended in an oscillating heated cup that contains the blood sample [4], leading to a graphical output (Fig. 1). Compared with traditional laboratory coagulation tests, the TEG takes into account the dynamic interaction of plasma (clotting factors) and cellular (platelets) elements that occurs during in vivo clotting, thus indicating overall 'clot quality.' Test protocols can

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Reference ranges for thromboelastography (TEG^®) and traditional coagulation tests in term parturients undergoing caesarean section under spinal anaesthesia*

Macafee¹,

Campbell²,

Ashpole

et al. 2012

Anaesthesia

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show abstract

“…10 In contrast, Boyce et al observed shorter r times and k times and wider alpha angles at three hours post-CD compared with indices recorded prior to surgery. 22 Sharma et al observed higher alpha angle values for postpartum women 12-24 hr postdelivery compared with term pregnant women. 8 Nevertheless, postpartum values were not measured in women post-CD, and no other significant differences were observed in other TEG indices in pregnant vs postpartum women.…”

Section: Discussionmentioning

confidence: 97%

“…Based on work by Ng et al, who observed associations between aging and r time, k time, a angle, and MA, 12 and Boyce et al, who observed that r time displays the greatest degree of change up to four hours post-elective CD, 22 we selected r time for calculating sample size in our study. To estimate differences in r times between study groups, the sample size was estimated from prior studies that reported the incidence and risk of VTE in pregnancy among AMA and non-AMA women 5,6 and from TEG data from our previous study investigating changes in the maternal coagulation profile before and after CD.…”

Section: Discussionmentioning

confidence: 99%

Impact de l’âge maternel avancé sur les profils de coagulation thrombo-élastographique du péripatum: une étude observationnelle prospective exploratoire

Butwick

Gutiérrez

Hilton

2014

Can J Anesth/J Can Anesth

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Purpose Advanced maternal age (AMA) is a known risk factor for pregnancy-related venous thromboembolism. However, it is unclear if underlying differences exist in the maternal coagulation profiles of AMA vs non-AMA women. The aim of this prospective observational study was to compare peripartum thromboelastography parameters of AMA and non-AMA women undergoing elective Cesarean delivery (CD). [25][26][27][28][29][30][31][32][33][34] yr in the AMA and non-AMA groups, respectively (P \ 0.001). We observed no statistically significant effect of study group on any thromboelastographic or laboratory coagulation parameters. No statistically significant correlations were found between any thromboelastographic parameter and maternal age. Peripartum thromboelastography and coagulation profiles of healthy AMA and healthy non-AMA women up to 72 hr post-CD were also similar. Conclusion These data suggest that maternal thromboelastographic profiles of healthy AMA and non-AMA women undergoing elective CD are similar. The study was registered at ClinicalTrials.gov (identifier: NCT01416454). Methods

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“…The thromboelastography may be able to detect and quantify the effect of unfractionated heparin. [18]…”

mentioning

confidence: 99%

Pharmacological thromboprophylaxis and epidural anaesthesia

Harsoor

Sudheesh

2012

Indian J Anaesth

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Use of thromboelastography to guide thromboprophylaxis after caesarean section

Cited by 15 publications

References 26 publications

Reference ranges for thromboelastography (TEG^®) and traditional coagulation tests in term parturients undergoing caesarean section under spinal anaesthesia*

Reference ranges for thromboelastography (TEG^®) and traditional coagulation tests in term parturients undergoing caesarean section under spinal anaesthesia*

Impact de l’âge maternel avancé sur les profils de coagulation thrombo-élastographique du péripatum: une étude observationnelle prospective exploratoire

Pharmacological thromboprophylaxis and epidural anaesthesia

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Use of thromboelastography to guide thromboprophylaxis after caesarean section

Cited by 15 publications

References 26 publications

Reference ranges for thromboelastography (TEG®) and traditional coagulation tests in term parturients undergoing caesarean section under spinal anaesthesia*

Reference ranges for thromboelastography (TEG®) and traditional coagulation tests in term parturients undergoing caesarean section under spinal anaesthesia*

Impact de l’âge maternel avancé sur les profils de coagulation thrombo-élastographique du péripatum: une étude observationnelle prospective exploratoire

Pharmacological thromboprophylaxis and epidural anaesthesia

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Product

Resources

About

Reference ranges for thromboelastography (TEG^®) and traditional coagulation tests in term parturients undergoing caesarean section under spinal anaesthesia*

Reference ranges for thromboelastography (TEG^®) and traditional coagulation tests in term parturients undergoing caesarean section under spinal anaesthesia*