Thromboelastography as a Predictor of Outcomes Following Liver Transplantation

Trautman, Christopher; Palmer, William C.; Taner, C. Burcin; Canabal, Juan M.; Getz, Trevor W.; Goldman, Abe; Heckman, Michael G.; Diehl, Nancy N.; Lee, David D.; Stancampiano, Fernando

doi:10.1016/j.transproceed.2017.07.015

Cited by 15 publications

(13 citation statements)

References 19 publications

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“…Compared with the traditional coagulation detection, TEG could comprehensively analyze the plasma composition and its influence on blood coagulation, which may better reflect the precise blood coagulation parameters of patients (32). TEG graphically demonstrates the process of coagulation, including the initiation, formation of blood clots and fibrinolysis using 20 standard parameters (33). TEG accurately reflects the presence of the hypercoagulable state in the blood (33).…”

Section: Discussionmentioning

confidence: 99%

“…TEG graphically demonstrates the process of coagulation, including the initiation, formation of blood clots and fibrinolysis using 20 standard parameters (33). TEG accurately reflects the presence of the hypercoagulable state in the blood (33). Compared with the conventional methods, TEG is more rapid and accurate, and is a sensitive test for the overall evaluation of coagulation function (34).…”

Section: Discussionmentioning

confidence: 99%

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Thromboelastography‑derived parameters for the prediction of acute thromboembolism following non‑steroidal anti‑inflammatory drug‑induced gastrointestinal bleeding: A retrospective study

et al. 2018

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Efficacy of thromboelastography (TEG)-derived parameters for the prediction of acute thromboembolism (AT) in patients with non-steroidal anti-inflammatory drug (NSAID)-induced gastrointestinal bleeding (GIB) remains to be determined. A retrospective propensity score matching (PSM) study was performed to evaluate this efficacy. Patients with NSAID-induced GIB (98 with AT; 830 without AT) were matched for age, sex and history of cardiovascular and cerebrovascular diseases using PSM. Multivariate logistic regression was used to determine the efficacy of TEG-derived predictors of AT. Mean Decrease Gini (MDG) coefficients were used to rank the importance of the variables from random forest algorithm results. Univariate analysis indicated that the following indexes were significantly different between the two groups: Reaction time (R value), coagulation forming time, solidification angle, maximum amplitude (MA), coagulation index (CI), hemoglobin levels, D-dimer levels, platelet aggregation test (pAgt) results, fibrinogen levels and Acute Physiology and Chronic Health Evaluation II score (all P<0.001). Multifactor logistic regression analysis indicated that the R value (P=0.010), solidification angle (P=0.004), MA (P=0.038), D-dimer levels (P=0.012) and pAgt results (P=0.015) were independent predictors of AT in patients with NSAID-induced GIB, achieving an area under the curve of 0.999 in receiver operating characteristic curve analyses. The five most important parameters according to the MDG scores (MDGS) were: Solidification angle (MDGS=58.14), R value (MDGS=20.42), pAgt results (MDGS=15.61), D-dimer levels (MDGS=12.78) and CI (MDGS=12.61). The results of the present study indicated that TEG-derived parameters including the R value, solidification angle, MA and CI, as well as D-dimer levels and pAgt score were significant predictors of AT in patients with NSAID-induced GIB.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Thromboelastography‑derived parameters for the prediction of acute thromboembolism following non‑steroidal anti‑inflammatory drug‑induced gastrointestinal bleeding: A retrospective study

et al. 2018

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“…Previous studies have indicated that TEG was beneficial in reducing blood transfusion during invasive procedures in patients with liver disease (8-10), and Thromboelastography maximum amplitude predicts short-term mortality in patients with hepatitis B virus-related acute-on-chronic liver failure predicting re-bleeding in patients with cirrhosis and variceal bleeding (5). Recently, TEG has been used as a tool to assess the prognosis of patients with liver disease (11)(12)(13). A retrospective study at the Mayo Clinic revealed that although post-LT TEG was not associated with mortality in patients who received LT, some parameters of TEG were predictive of the increased length of hospitalization and early allograft dysfunction (EAD) (11).…”

Section: Introductionmentioning

confidence: 99%

“…Recently, TEG has been used as a tool to assess the prognosis of patients with liver disease ( 11-13 ). A retrospective study at the Mayo Clinic revealed that although post-LT TEG was not associated with mortality in patients who received LT, some parameters of TEG were predictive of the increased length of hospitalization and early allograft dysfunction (EAD) ( 11 ). Recently, Premkumar et al ( 12 ) indicated that the TEG parameter coagulation index (CI) and lysis at 30 min (LY30) were two independent predictors of mortality in patients with ACLF.…”

Section: Introductionmentioning

confidence: 99%

Thromboelastography maximum amplitude predicts short‑term mortality in patients with hepatitis B virus‑related acute‑on‑chronic liver failure

Zhu

Ke³

et al. 2020

Exp Ther Med

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Patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) exhibit complex hemostatic defects. Thromboelastography (TEG) can be used to reveal global hemostasis in patients with liver disease; however, little is known about the association between TEG and the outcome of patients with HBV-related ACLF. The present study aimed to investigate the value of TEG for predicting 90 day mortality in patients with HBV-related ACLF. A total of 51 patients with HBV-related ACLF, 26 patients with chronic hepatitis B (CHB) and 26 healthy controls (HC) were enrolled in the present study. TEG, standard coagulation tests, routine blood tests, biochemical markers and demographic variables were recorded and assessed for prognostic value. The results indicated that a prolonged reaction and kinetics (K) time, a shortened α angle and a decreased maximum amplitude (MA) and coagulation index (CI) were observed in patients with HBV-related ACLF, compared with CHB and HC subjects. Patients with HBV-related ACLF in the mortality group exhibited a decrease in α angle, MA, lysis at 30 min, CI, fibrinogen and platelet count, and an increase in K time, international normalized ratio (INR) and the model for end-stage liver disease (MELD) score in comparison with the survival group. MA and INR were two independent predictors of 90 day mortality in patients with HBV-related ACLF, with hazard ratios of 0.918 (95% CI, 0.867-0.971; P=0.003) and 3.141 (95% CI, 1.843-5.354; P<0.001) respectively. When predicting 90 day mortality, MA + INR exhibited the highest area under the receiver operating characteristic curve, followed by INR, MELD score and MA. Patients with ACLF and MA ≤51.5 mm exhibited a poorer outcome than those with MA >51.5 mm, as revealed via the Kaplan-Meier analysis. In summary, the findings of the present study suggested that TEG MA was associated with 90 day mortality in patients with HBV-related ACLF, and a combination of MA and INR was superior to MA, INR and MELD score in terms of prognostic value.

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“…Therefore, TEG is likely to be valuable for appraising coagulation status and the response to anticlotting therapy. Currently, TEG has been used in various clinical conditions, such as in pregnant patients, in obstetric patients, liver transplantation, cardiac surgery, myocardial infarction, and in trauma patients [9][10][11][12][13][14]. One of the most crucial advantages of TEG is the comprehensive global assessment to the coagulation process preceding routine tests [15].…”

Section: Introductionmentioning

confidence: 99%

Thromboelastography in Patients with Inflammatory Bowel Disease

Shen

Shi

Zhang

et al. 2020

Gastroenterology Research and Practice

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Purpose. Patients with inflammatory bowel disease (IBD) frequently suffer from venous thromboembolic events, and the risk of thromboembolism increases along with disease activity. This study was conducted to discover novel thrombophilic markers using thromboelastography (TEG) and to evaluate the relation between the predisposing factors and the activity of disease in Chinese patients with Crohn’s disease (CD) and ulcerative colitis (UC). Methods. Thirty-four patients with CD, 29 patients with UC, and 53 healthy volunteers were enrolled into this study. Blood levels of R, K, α Angle, G, maximal amplitude (MA), and LY30 with TEG were determined. Results. Mean values of R, K, α Angle, G, and MA were significantly different in patients with CD and UC compared with the healthy individuals. Patients with active CD had different K, α Angle, G, and MA levels compared with patients in remission (P<0.05, P<0.001, P<0.001, and P<0.001). Levels of R, α Angle, G, and MA were also significantly different in active UC patients compared with those in remission (P<0.01, P<0.001, P<0.001, and P<0.001). Except for the G level in the CD group, differences in all TEG levels between healthy individuals and IBD patients in remission were not statistically significant. No statistical differences were observed in LY30 among patients with active phase, patients in remission, and the healthy individuals. Conclusion. Thrombophilic defects are common in Chinese patients with IBD, and TEG can be considered a new direction to anticoagulant thromboprophylaxis in IBD.

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Thromboelastography as a Predictor of Outcomes Following Liver Transplantation

Cited by 15 publications

References 19 publications

Thromboelastography‑derived parameters for the prediction of acute thromboembolism following non‑steroidal anti‑inflammatory drug‑induced gastrointestinal bleeding: A retrospective study

Thromboelastography‑derived parameters for the prediction of acute thromboembolism following non‑steroidal anti‑inflammatory drug‑induced gastrointestinal bleeding: A retrospective study

Thromboelastography maximum amplitude predicts short‑term mortality in patients with hepatitis B virus‑related acute‑on‑chronic liver failure

Thromboelastography in Patients with Inflammatory Bowel Disease

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