Thromboelastographic predictors of venous thromboembolic events in critically ill patients

Abstract

Deep venous thromboembolism and pulmonary embolism are still underdiagnosed in the ICU. Thromboelastography (TEG) has shown considerable variability in sensitivity and specificity as a predictor of venous thromboembolism (VTE). We designed a prospective double-blind observational study to predict the risk of VTE using TEG in a cohort of critically ill patients. Seventy-two hours after admission in the ICU and consequent prophylaxis with low-molecular-weight heparin, we performed compressive color-Doppler ultrasound and diagnosed deep venous thrombosis. Computed tomography scan was performed for the diagnosis of pulmonary embolism if pulmonary embolism was suspected based on physical examination and transthoracic echocardiography. Whole blood samples were obtained from central venous lines 6-8 h after subcutaneous administration of low-molecular-weight heparin. Native TEG and modified heparinase TEG were performed using a Thromboelastograph Coagulation Analyzer. Fifty-seven patients were consecutively enrolled of which six (10.5%) developed deep venous thrombosis; two (3.5%) also developed pulmonary embolism. The native thrombodynamic ratio (TDR) was an independent predictor of the odds of thrombosis (odds ratio 1.016, P < 0.05, 95% confidence interval 1.008-1.047), with a 0.93 area under the ROC curve. Using 10.6 as the lower cut-off point, TDR showed 100% sensitivity and 0 negative likelihood ratio (95% confidence interval 0-0.4) in excluding the clinical diagnosis of VTE. Our results show that TDR predicts VTE in the ICU. Our findings are in agreement with those reported by other investigators, who demonstrated that a TDR less that 10 is associated with prophylactic levels of anti-Xa.

The role of viscoelastic testing in the management of the parturient

“…The same result has been observed when viscoelastic‐based testing has been compared against standard coagulation testing 15 . In addition to better hemorrhage control, viscoelastic testing has been shown to be predictive of venous thromboembolic events in the critically ill 16,17 …”

“…The same result has been observed when viscoelastic-based testing has been compared against standard coagulation testing. 15 In addition to better hemorrhage control, viscoelastic testing has been shown to be predictive of venous thromboembolic events in the critically ill. 16,17 The incidence of maternal death in the United States is on the rise. Twenty percent of these deaths result from coagulation dysfunction, for example, hemorrhage or thrombotic complications.…”

Use of viscoelastic tests to predict clinical thromboembolic events: A systematic review and meta‐analysis

“…Of the 4963 studies identified in the databases, 41 studies from 14 countries, including 10,818 patients in a variety of clinical settings, met the inclusion criteria and were subject to meta‐analysis (Figure ) . A list of the studies excluded and the reasons for their exclusion are summarized in Appendix .…”

Clinical Application of Thromboelastography in Acute Ischemic Stroke

“…Moreover, TDR less than 10.6 could rule out VTE (100% sensitivity and 0 negative likelihood ratio). 50 However, in a study of emergency care, no TEG parameters were related to VTE. 51 Pre-stenting TEG parameters were found to be related to ischemic events after carotid stenting in a prospective study.…”