Normal range values for thromboelastography in healthy adult volunteers

Scarpelini, Sandro; Rhind, Shawn G.; Nascimento, Bartolomeu; Tien, Homer; Shek, Pang N.; Peng, Henry T.; Huang, Hung‐Tsai; Pinto, Ruxandra; Speers, Vanessa; Reis, Marciano D.; Rizoli, Sandro

doi:10.1590/s0100-879x2009001200015

Cited by 153 publications

(165 citation statements)

References 37 publications

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“…One striking finding was that the analysis population had a median of 5/28 test results per patient that were abnormal (range 0‐18) when compared to healthy control reference intervals, which were similar in our study to previously published reference intervals 37, 38, 39…”

Section: Discussionsupporting

confidence: 89%

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Mumford

Harris

Plummer

et al. 2017

Research and Practice in Thrombosis and Haemostasis

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Essentials Near‐patient testing improves coagulopathy diagnosis in cardiac surgery patients with severe bleeding.We investigated how well pre‐emptive near‐patient testing predicted severe bleeding.Severe bleeding could be predicted using both near‐patient tests and patient clinical characteristics.Near‐patient test results gave little additional predictive value over clinical characteristics alone. BackgroundCoagulopathic bleeding is common after cardiac surgery and is associated with increased morbidity, mortality and healthcare costs. Implementation of blood management algorithms in which patients with severe bleeding undergo near‐patient coagulation testing results in less overall bleeding and transfusion. However, it is unknown whether there is additional value from pre‐emptive near‐patient testing to predict whether severe bleeding will occur.ObjectivesTo evaluate how well a comprehensive panel of 28 near‐patient platelet and viscoelastometry tests predict bleeding after cardiac surgery, compared to prediction using baseline clinical characteristics alone.MethodsSingle‐center, prospective cohort study in adults undergoing a range of cardiac surgery procedures. The primary outcome was clinical concern about bleeding (CCB), a composite of high blood loss (chest drain volume >600 mL within 6 hours), re‐operation for bleeding or administration of a pro‐haemostatic treatment directed by clinician judgement.ResultsIn 1833 patients recruited between March 2010 and August 2012, the median number of abnormal near‐patient test results was 5/28 per patient (range 0‐18). CCB occurred in 449/1833 patients (24.5%). The c‐statistic for a predictive model for CCB using only baseline clinical characteristics (baseline‐only model) was 0.72 (95% CI 0.69‐0.75). Addition of near‐patient test results to this model (baseline‐plus‐test model) improved the prediction of CCB (c‐statistic 0.75 [0.72‐0.77]), but increased the number of correctly classified patients by only 18 (0.98%).ConclusionsNear‐patient coagulation testing predicts bleeding in cardiac surgery patients, but offers little improvement in prediction compared to baseline clinical characteristics alone. trial registration: ISRNCTN 20778544 (http://www.isrctn.com/).

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Section: Discussionsupporting

confidence: 89%

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Mumford

Harris

Plummer

et al. 2017

Research and Practice in Thrombosis and Haemostasis

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“…This may be attributable to the effect of modification by citrate, heparinase and kaolin activation used in the current study. This hypothesis is supported by the fact that the results for TEG in adults by Miller et al6 also differs from other published studies 3 5 8 13. Kaolin is a common additive to help accelerate clot formation 1.…”

Section: Discussionmentioning

confidence: 80%

“…The clot formation and degradation is described by the following TEG variables: (1) clotting time (R): time to initial fibrin formation; (2) clot kinetics (K): time until specific clot strength of 20 mm obtained; (3) α angle (α): rate of clot formation (fibrin accumulation and cross-linking); (4) maximum amplitude (MA): final strength of the clot; (5) fibrinolysis or rate of clot breakdown (LY30): amplitude 30 min after MA achieved; and (6) coagulation index (CI): derived linear calculation of R, K, α and MA (figure 1). 3…”

Section: Methodsmentioning

confidence: 99%

Thromboelastography in term neonates: an alternative approach to evaluating coagulopathy

Sewell

Forman

Wong

et al. 2016

Arch Dis Child Fetal Neonatal Ed

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“…Previous comparative studies to assess the interchangeability between TEG and RoTEM have been reported [24,31]. Even if TEG and RoTEM are very similar instruments, there are some differences between them.…”

Section: Resultsmentioning

confidence: 99%

Comparison of three point-of-care testing devices to detect hemostatic changes in adult elective cardiac surgery: a prospective observational study

et al. 2014

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BackgroundBleeding complications in cardiac surgery may lead to increased morbidity and mortality. Traditional blood coagulation tests are not always suitable to detect rapid changes in the patient's coagulation status. Point-of-care instruments such as the TEG (thromboelastograph) and RoTEM (thromboelastometer) have been shown to be useful as a guide for the clinician in the choice of blood products and they may lead to a reduction in the need for blood transfusion, contributing to better patient blood management.MethodsThe purpose of this study was to evaluate the ability of the TEG, RoTEM and Sonoclot instruments to detect changes in hemostasis in elective cardiac surgery with cardiopulmonary bypass and to investigate possible correlations between variables from these three instruments and routine hematological coagulation tests. Blood samples from thirty-five adult patients were drawn before and after surgery and analyzed in TEG, RoTEM, Sonoclot and routine coagulation tests. Data were compared using repeated measures analysis of variance and Pearson's test for linear correlation.ResultsWe found significant changes for all TEG variables after surgery, for three of the RoTEM variables, and for one variable from the Sonoclot. There were significant correlations postoperatively between plasma fibrinogen levels and variables from the three instruments.ConclusionsTEG and RoTEM may be used to detect changes in hemostasis following cardiac surgery with CPB. Sonoclot seems to be less suitable to detect such changes. Variables from the three instruments correlated with plasma fibrinogen and could be used to monitor treatment with fibrinogen concentrate.

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Normal range values for thromboelastography in healthy adult volunteers

Cited by 153 publications

References 37 publications

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Thromboelastography in term neonates: an alternative approach to evaluating coagulopathy

Comparison of three point-of-care testing devices to detect hemostatic changes in adult elective cardiac surgery: a prospective observational study

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