Clinical utility of viscoelastic testing (TEG and ROTEM analyzers) in the management of old and new therapies for hemophilia

Ramiz, Sarah; Hartmann, Jan; Escobar, Miguel A.; Chitlur, Meera

doi:10.1002/ajh.25319

Cited by 32 publications

(44 citation statements)

References 45 publications

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“…Because of the paucity of high‐quality studies, our analysis is based on cardiovascular surgery and liver surgery as key elective surgery settings, and trauma as an emergency setting. However, it is important to highlight that there are potential benefits of employing TEG in other settings, such as obstetrics, monitoring patients with congenital bleeding disorders, and assessing the coagulation status of stroke patients . Our analysis has provided an up‐to‐date overview of the benefits of TEG‐guided transfusion in both an elective surgery setting and an emergency setting.…”

Section: Discussionmentioning

confidence: 99%

Thromboelastography‐guided therapy improves patient blood management and certain clinical outcomes in elective cardiac and liver surgery and emergency resuscitation: A systematic review and analysis

Dias¹,

Sauaia

Achneck

et al. 2019

Journal of Thrombosis and Haemostasis

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Background: Thromboelastography (TEG 5000 and 6s Thrombelastograph Hemostasis Analyzer; Haemonetics) is a point-of-care system designed to monitor and analyze the entire coagulation process in real time. TEG-guided therapy has been shown to be valuable in a variety of surgical settings. Objective:To conduct an analysis of published clinical trials to evaluate the effects of TEGguided transfusion for the management of perioperative bleeding on patient outcomes. Patients/Methods:We searched MEDLINE (PubMed) and EMBASE for original articles reporting studies using TEG vs controls in a perioperative setting for inclusion in this systematic review. We identified nine eligible randomized controlled trials (RCTs) in two elective surgery settings (cardiac surgery and liver surgery), but only one RCT in the emergency setting. Results:In the elective surgery study meta-analysis, platelet (P = 0.004), plasma (P < 0.001) and red blood cell transfusion (P = 0.14), operating room length of stay (LoS) (P = 0.005), intensive care unit LoS (P = 0.04) and bleeding rate (P = 0.002) were reduced with TEGguided transfusion vs controls. Although blood product use was reduced, rates of mortality remained comparable between the TEG group and control group. In the emergency setting evaluation, the RCT reported lower mortality in the TEG group than in the control group (P = 0.049). In addition, there were significant reductions in platelet and plasma transfusion (P = 0.04 and P = 0.02, respectively), and the number of ventilator-free days increased, in the TEG group as compared with the control group (P = 0.10). Conclusions:This systematic review and analysis indicate that TEG-guided hemostatic therapy can enhance blood product management and improve key patient outcomes, including LoS, bleeding rate, and mortality.Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Dias JD, Sauaia A, Achneck HE, Hartmann J, Moore EE. Thromboelastography-guided therapy improves patient blood management and certain clinical outcomes in elective cardiac and liver surgery and emergency resuscitation: A systematic review and analysis. J Thromb Haemost. 2019;17:984-994. https ://doi.org/

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Section: Discussionmentioning

confidence: 99%

Thromboelastography‐guided therapy improves patient blood management and certain clinical outcomes in elective cardiac and liver surgery and emergency resuscitation: A systematic review and analysis

Dias¹,

Sauaia

Achneck

et al. 2019

Journal of Thrombosis and Haemostasis

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“…The TEG ® 6s hemostasis analyzer is a fully automated diagnostic instrument, employing a four channel cartridge system to quantify the viscoelastic properties of a whole blood clot from the enzymatic phase through to the fibrinolytic phase [20][21][22]. Four independent assays are conducted to provide a comprehensive overview of the patients' coagulation status (citrated kaolin [CK], citrated kaolin with heparinase [CKH], citrated rapidTEG ® [CRT], and citrated functional fibrinogen [CFF]).…”

Section: Teg®6smentioning

confidence: 99%

Comparison of three common whole blood platelet function tests for in vitro P2Y12 induced platelet inhibition

Dias¹,

Pottgießer

Hartmann

et al. 2019

J Thromb Thrombolysis

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In the context of interventional cardiology, platelet function testing may identify patients treated with P2Y12-inhibitors at an increased risk of mortality, thrombosis and bleeding. Several whole blood point-of-care platelet function analyzers are available; however, inter-device differences have not been examined systematically. To compare three platelet function tests under standardized in vitro conditions. Healthy volunteer (n = 10) blood samples were spiked with increasing concentrations of ticagrelor (0-7500 ng/mL) and/or ASA (0-3280 ng/mL), measured on three platelet function analyzers (TEG ® 6s, Multiplate ® , and VerifyNow ®) and respective Effective Concentration (EC) levels EC10, EC50 and EC90 were calculated. Repeatability was assessed in a separate group of pooled blood samples (n = 10) spiked with ticagrelor at EC10, EC50 and EC90. ASA had no impact on ADP-activated channels for all three devices. TEG ® 6s was able to distinguish (p ≤ 0.05) between all ticagrelor EC zones; VerifyNow ® and Multiplate ® were able to distinguish between three and two zones, respectively. Multiplate ® showed the largest window between EC10 and EC90 (19-9153 ng/mL), followed by TEG ® 6s (144-2589 ng/mL), and VerifyNow ® (191-1100 ng/mL). Drug effect models distribution of disagreements were identified for TEG ® 6s (5.0%), VerifyNow ® (8.3%), and Multiplate ® (13.3%). TEG ® 6s showed the smallest average coefficient of variation between EC conditions (5.1%), followed by Multiplate ® (14.1%), and VerifyNow ® (17.7%). Linear models could be generated between TEG ® 6s and Multiplate ® , but not VerifyNow ®. Significant differences were found between whole blood point-of-care platelet function analyzers and the clinical impact of these differences needs to be further investigated.

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“…TEG® (Haemonetics Corporation, Braintree, MA, USA) has been used in clinical practice for decades to quantify fibrinolysis, coagulability, and the effects of antithrombotic and anticoagulant therapy [7,8]. TEG® hemostasis analyzers measure the viscoelastic properties of a clot from the enzymatic phase through to the fibrinolytic phase [9].…”

Section: Introductionmentioning

confidence: 99%

TEG®6s system measures the contributions of both platelet count and platelet function to clot formation at the site-of-care

Dias¹,

Lopez-Espina

Bliden

et al. 2019

Platelets

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Knowledge of platelet count and function is key to ensuring appropriate hemostatic management. We hypothesized that the novel, portable TEG®6s coagulation assessment system could evaluate the contribution of both platelet count and function to clot formation. Whole-blood samples with variable platelet counts were prepared from healthy volunteers. Platelet function was adjusted using seven concentrations of abciximab and evaluated by light transmission aggregometry (LTA) with TRAP agonist. Maximum amplitude (MA), reaction time (R) and activated clotting time (ACT) were assessed in citrated kaolin (CK), CK with heparinase (CKH), citrated RapidTEG® (CRT), and citrated functional fibrinogen (CFF) assays. Positive correlations were observed between platelet count and CK.MA, CKH.MA, and CRT.MA (p < .0001), and CK.R, CKH.R, and CRT.ACT (p < .05). Platelet count could be accurately quantified in the range 28-91 k/μL, 28-86 k/μL and 28-74 k/μL for CK.MA, CKH.MA, and CRT.MA, respectively. CK.MA, CKH.MA, and CRT.MA showed significant negative relationships with abciximab concentration (p < .001). Platelet function inhibition was detected by all three assays at >68% measured by LTA and quantified in the range 68.4-82% (CK), 69.4-88% (CKH), and 69.7-76% (CRT). This demonstrates the TEG®6s analyzer can accurately evaluate platelet count and function at the site-of-care.

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Clinical utility of viscoelastic testing (TEG and ROTEM analyzers) in the management of old and new therapies for hemophilia

Cited by 32 publications

References 45 publications

Thromboelastography‐guided therapy improves patient blood management and certain clinical outcomes in elective cardiac and liver surgery and emergency resuscitation: A systematic review and analysis

Thromboelastography‐guided therapy improves patient blood management and certain clinical outcomes in elective cardiac and liver surgery and emergency resuscitation: A systematic review and analysis

Comparison of three common whole blood platelet function tests for in vitro P2Y12 induced platelet inhibition

TEG®6s system measures the contributions of both platelet count and platelet function to clot formation at the site-of-care

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