Thromboelastography as a Surrogate Marker of Perisurgical Hemostasis in Gaucher Disease

Abstract

Thromboelastography (TEG) has long been available for routine monitoring of perisurgical and postpartum hemostasis, especially at point of care. The purpose of this study is to retrospectively compare TEG parameters to concomitant standard clotting test results in an unselected cohort of patients with Gaucher disease to ascertain whether TEG values are specific and sensitive enough to substitute for classic coagulation tests for decision making. This remains a cogent concern because of high incidence of thrombocytopenia in patients with Gaucher disease. Thromboelastography values were compared to concomitant platelet counts, partial thromboplastin time, international normalization ratio, and plasma fibrinogen. Demographic characteristics were collected from patients' files. There were 22 patients with Gaucher disease (2 children; 12.5%) for whom there were 24 TEG results at the same time as classic coagulation test results and 30% performed platelet function tests. The current study shows linear and/or monotonic relationships between platelet counts and several TEG values that were significant over a range of platelet counts including severe thrombocytopenia. The fibrinogen component, correlating only with the rate of clot lysis, played a lesser role. Based on these preliminary results albeit in a small cohort with only 1 case of hemorrhage, there is putative support for the intention to treat patients with Gaucher disease based on TEG results using the same TEG protocol as for other patients undergoing comparable procedures in our institution.

How we manage Gaucher Disease in the era of choices

“…All rights reserved Orthopaedic surgery is still commonly needed, mainly arthroplasties (including revisions) due to osteonecrosis that occurred before the availability of ERT. The success of surgical procedures in GD is improved with effective multi-disciplinary preparation, particularly including a haematologist [for prevention of excessive bleeding (Spectre, et al 2011)], a general physician (for infection prevention, if needed) and an anaesthetist, for overall planning including bleeding prevention (Ioscovich, et al 2006, Ioscovich, et al 2016.…”

The influence of sodium hypochlorite concentration on the fibrin structure of human blood clots and transforming growth factor-beta 1 release: an ex vivo study

“…A graphic representation of the clotting kinetics obtained with BN 5.25 shows that the quality parameters of the clot formed were not within normal ranges. The TEG R value signified the initiation of fibrin deposition [ 21 ]. The R values of BN 0.5 and BN 3 were 7-11 times longer than the CG and showed no clot formation, even after 40 minutes.…”

“…The graphical representation of BN 5.25 showed that it was 5 times longer than the CG, suggesting altered initiation of fibrin deposition. The K value indicates the time taken to reach a certain level of clot strength, the α indicates the rapidity of fiber build-up and cross-linking, and the MA indicates the direct function of the properties of fibrin and platelet aggregation [ 21 ]. Although the K, MA, and α values were not recorded for BN 0.5 and BN 3 , for BN 5.25 they were 2.8 times greater, 1.3 times greater, and 2 times less than CG, respectively.…”

Hemostatic Abnormalities in Gaucher Disease: Mechanisms and Clinical Implications

“…Thromboelastography (TEG) may be an alternative option to evaluate the bleeding tendency in a peri-surgical or predelivery setting [ 86 ]. TEG provides a quick and visualized monitoring and analysis of the viscoelastic properties of clot formation and dissolution in whole blood.…”