Thromboelastographic Changes in Healthy Parturients and Postpartum Women

Abstract

Thromboelastography (TEG) using disposable plastic cups and pins was performed with native whole blood (native group) in 17 nonpregnant volunteers, 134 healthy term pregnant women (>36 wk gestation), and 69 postpartum women. Thromboelastography was also performed with celite-activated whole blood (celite group) in 15 nonpregnant female volunteers, 38 healthy term pregnant women, and 34 postpartum women. The thromboelastographic parameters r and K were significantly decreased in pregnant and postpartum women compared with nonpregnant women in both groups (P < 0.05). The maximum amplitude MA, elastic shear modulus, and alpha angles were significantly increased in pregnant and postpartum women compared with nonpregnant women in both groups (P < 0.05). The TEG coagulation index was significantly greater in pregnant and postpartum women compared with nonpregnant women in both groups. In this study, TEG showed that pregnancy is a hypercoagulable state and that postpartum women remain hypercoagulable through the first 24 h postdelivery. The use of celite in TEG accelerated the speed of TEG analysis.

Assessment of coagulation in the obstetric population using ROTEM® thromboelastometry

“…12 Sharma et al used the thromboelastograph to show that the hypercoagulable changes associated with pregnancy were present until 12-24 h postpartum. 13 Steer et al performed a study involving standard thromboelastography with 41 women at the end of pregnancy and reported a decrease in clotting time suggesting coagulation is acti- vated in pregnancy whereas other studies have suggested a hyperactivation (enhanced initiation of coagulation) of coagulation in pregnancy based on high levels of coagulation activation markers (prothrombin fragments F1+2 and thrombin-antithrombin complexes) found in maternal blood. [14][15][16] In agreement with Steer et al our results suggest that in pregnancy the initiation of clotting, thrombin formation and start of clot polymerisation is increased as well as the response of the coagulation process once it has been initiated (as demonstrated by lower CFT-INTEM Ò and CFT-EXTEM Ò values found during pregnancy).…”

Use of thromboelastography to guide thromboprophylaxis after caesarean section

“…The hypercoagulable state of pregnancy has been clearly demonstrated by TEG, [24][25][26] and CS further promotes this thrombotic tendency. [1][2][3] However there are limited data assessing TEG changes during the perioperative CS period.…”

Blood component therapy guided by celite-activated thromboelastography for perioperative coagulopathy

“…Celite-induced factor XII activation accelerates thrombin formation, leading to more rapid assessment of coagulation status. Sharma et al [7] reported an up to fourfold reduction in R time, and an up to 73% increase in α angle when celite-activated TEG was compared with native TEG in pregnant women. Yamakage et al [8] also reported that celite-activated TEG resulted in an approximately 50% reduction in R time and a 19% increase in MA when compared with native TEG.…”

“…Clinically, TEG was shown to be effective in guiding transfusion therapy in the early days of liver transplantation [2]. Further modifications of TEG, including celite activation and heparinase, have been introduced, making TEG a "point-of-care" coagulation monitor in a wide variety of surgical procedures [3][4][5][6][7]. At our institution, TEG with celite activation is performed in the operating room by anesthesiologists.…”

“…With the use of celite as a coagulation activator, the blood is activated more rapidly and homogeneously, leading to a more rapid assessment of coagulation status. Reduced time for obtaining the maximum amplitude and lysis index is a clear advantage over the conventional TEG [7,8]. We report three patients in whom on-site TEG (C-TEG3000T; Haemoscope, Niles, IL, USA) was useful in monitoring coagulation status and guiding the blood component therapy.…”