Thromboelastography‐guided therapy improves patient blood management and certain clinical outcomes in elective cardiac and liver surgery and emergency resuscitation: A systematic review and analysis

Abstract

Background: Thromboelastography (TEG 5000 and 6s Thrombelastograph Hemostasis Analyzer; Haemonetics) is a point-of-care system designed to monitor and analyze the entire coagulation process in real time. TEG-guided therapy has been shown to be valuable in a variety of surgical settings. Objective:To conduct an analysis of published clinical trials to evaluate the effects of TEGguided transfusion for the management of perioperative bleeding on patient outcomes. Patients/Methods:We searched MEDLINE (PubMed) and EMBASE for original articles reporting studies using TEG vs controls in a perioperative setting for inclusion in this systematic review. We identified nine eligible randomized controlled trials (RCTs) in two elective surgery settings (cardiac surgery and liver surgery), but only one RCT in the emergency setting. Results:In the elective surgery study meta-analysis, platelet (P = 0.004), plasma (P < 0.001) and red blood cell transfusion (P = 0.14), operating room length of stay (LoS) (P = 0.005), intensive care unit LoS (P = 0.04) and bleeding rate (P = 0.002) were reduced with TEGguided transfusion vs controls. Although blood product use was reduced, rates of mortality remained comparable between the TEG group and control group. In the emergency setting evaluation, the RCT reported lower mortality in the TEG group than in the control group (P = 0.049). In addition, there were significant reductions in platelet and plasma transfusion (P = 0.04 and P = 0.02, respectively), and the number of ventilator-free days increased, in the TEG group as compared with the control group (P = 0.10). Conclusions:This systematic review and analysis indicate that TEG-guided hemostatic therapy can enhance blood product management and improve key patient outcomes, including LoS, bleeding rate, and mortality.Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Dias JD, Sauaia A, Achneck HE, Hartmann J, Moore EE. Thromboelastography-guided therapy improves patient blood management and certain clinical outcomes in elective cardiac and liver surgery and emergency resuscitation: A systematic review and analysis. J Thromb Haemost. 2019;17:984-994. https ://doi.org/

Comparison of three common whole blood platelet function tests for in vitro P2Y12 induced platelet inhibition

“…Thromboelastography (TEG ® ) (Haemonetics, Braintree, MA, USA), Multiplate ® (Roche Diagnostics, Rotkreuz, Switzerland), PFA-100/PFA-200 (Siemens, Munich, Germany) and VerifyNow ® (Accumetrics, San Diego, CA, USA) systems are the most frequently studied. TEG ® PlateletMapping ® has been shown to be predictive of bleeding and thrombotic risk in patients undergoing PCI [7,8], cardiac [9][10][11], and non-cardiac surgery [11,12]; and the TEG ® DOAC cartridge can detect and classify direct oral anticoagulants with high specificity and sensitivity [13]. The clinical value of Multiplate ® in patients undergoing PCI or cardiac surgery [14][15][16], and VerifyNow ® in patients undergoing cardiac surgery [17,18] has also been established.…”

Anti Xa activity after high dose LMWH thrombosis prophylaxis in covid 19 patients at the intensive care unit

“…Two weeks after introduction of this high-dose thrombosis prophylaxis twice weekly anti Xa concentrations were evaluated. In recent years the use of viscoelastic hemostatic assays has been the focus of research in management of coagulopathy after cardiovascular surgery, other major surgery and trauma [ 7 ]. To investigate if viscoelastic testing might have a role in understanding the coagulopathy in the group of covid-19 patients, thromboelastography (TEG) assay was performed.…”

Diagnosis and Treatment of Trauma-Induced Coagulopathy by Viscoelastography

“…Although there is vigorous debate regarding the reproducibility of these VETs, for trauma patients who require massive transfusion with prohemostatic agents, these tests offer the same benefit in clinical outcomes as they have demonstrated for liver transplantations and the cardiac surgery patients. 119,120 With the evolution to a simplified tube or cartridge system and because of a new investigational cartridge system that can reliably predict DOAC activity, one can anticipate increased utilization of these tests at the site of care. Peripheral debates concerning the sensitivity of the VETs to guide the utilization of TXA in trauma do not detract from the welldesigned studies which show decreased mortality and blood utilization in those trauma patients whose resuscitation is guided by VETs.…”