Thromboelastography in Microsurgical Reconstruction: A Systematic Review

Thakkar, Mehul; Rose, Anna; Bednarz, Bartlomiej

doi:10.1016/j.jpra.2021.12.005

Cited by 7 publications

(6 citation statements)

References 24 publications

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“…A clot waveform analysis (CWA) can enhance the ability of APTT and PT, 25 and a CWA-APTT is useful for analyzing hemostatic abnormalities and monitoring anticoagulant therapy, 26 - 28 while a small amount of TF-induced FIX activation assay (sTF/FIXa) using platelet-rich plasma (PRP) can evaluate hemostatic abnormalities and hypercoagulability. 28 A thrombin generation test (TGT) 29 and thromboelastogram (TEG) 30 can also help visualize the clotting process and provide more information than conventional clotting assays; however, these assays are expensive and are generally used only in research. Compared to the TGT and TEG, 29 , 30 the recently developed CWA using a fully automated optical coagulation analyzer can easily analyze hemostatic abnormalities.…”

Section: Introductionmentioning

confidence: 99%

“… 28 A thrombin generation test (TGT) 29 and thromboelastogram (TEG) 30 can also help visualize the clotting process and provide more information than conventional clotting assays; however, these assays are expensive and are generally used only in research. Compared to the TGT and TEG, 29 , 30 the recently developed CWA using a fully automated optical coagulation analyzer can easily analyze hemostatic abnormalities.…”

Section: Introductionmentioning

confidence: 99%

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Detection of a Prethrombotic State in Patients with Hepatocellular Carcinoma, Using a Clot Waveform Analysis

Fukui,

Wada,

Ikeda

et al. 2024

Clin Appl Thromb Hemost

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Background: Although hepatocellular carcinoma (HCC) is frequently associated with thrombosis, it is also associated with liver cirrhosis (LC) which causes hemostatic abnormalities. Therefore, hemostatic abnormalities in patients with HCC were examined using a clot waveform analysis (CWA). Methods: Hemostatic abnormalities in 88 samples from HCC patients, 48 samples from LC patients and 153 samples from patients with chronic liver diseases (CH) were examined using a CWA-activated partial thromboplastin time (APTT) and small amount of tissue factor induced FIX activation (sTF/FIXa) assay. Results: There were no significant differences in the peak time on CWA-APTT among HCC, LC, and CH, and the peak heights of CWA-APTT were significantly higher in HCC and CH than in HVs and LC. The peak heights of the CWA-sTF/FIXa were significantly higher in HCC than in LC. The peak times of the CWA-APTT were significantly longer in stages B, C, and D than in stage A or cases of response. In the receiver operating characteristic (ROC) curve, the fibrin formation height (FFH) of the CWA-APTT and CWA-sTF/FIXa showed the highest diagnostic ability for HCC and LC, respectively. Thrombosis was observed in 13 HCC patients, and arterial thrombosis and portal vein thrombosis were frequently associated with HCC without LC and HCC with LC, respectively. In ROC, the peak time×peak height of the first derivative on the CWA-sTF/FIXa showed the highest diagnostic ability for thrombosis. Conclusion: The CWA-APTT and CWA-sTF/FIXa can increase the evaluability of HCC including the association with LC and thrombotic complications.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Detection of a Prethrombotic State in Patients with Hepatocellular Carcinoma, Using a Clot Waveform Analysis

Fukui,

Wada,

Ikeda

et al. 2024

Clin Appl Thromb Hemost

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“…Although conventional clotting assays such as the APTT, PT, and TT are inexpensive, easy, and automated, enabling the measurement of multiple samples, they cannot visualize the clotting process. A thrombin generation test (TGT) [6] and thromboelastogram (TEG) [7] can help visualize the clotting process and provide more information than conventional clotting assays; however, these assays are expensive and are generally used only in research. Compared to the TGT and TEG [6,7], the recently developed CWA using a fully automated optical coagulation analyzer can easily analyze hemostatic abnormalities.…”

Section: Introductionmentioning

confidence: 99%

“…CWA-APTT is most frequently used in the diagnosis of hemostatic abnormalities, such as hemophilia [8], inhibition of clotting factor [9], disseminated intravascular coagulation (DIC) [10], and lupus anticoagulant (LA) [7,11]. There is still little evidence to support the clinical usefulness of CWA-PT and CWA-TT, as their short peak times make them more difficult to visualize and analyze.…”

Section: Introductionmentioning

confidence: 99%

Clot Waveform Analysis for Hemostatic Abnormalities

et al. 2023

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Clot waveform analysis (CWA) observes changes in transparency in a plasma sample based on clotting tests such as activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT). Evidence indicates that not only an abnormal waveform but also peak times and heights in derivative curves of CWA are useful for the evaluation of hemostatic abnormalities. Modified CWA, including the PT with APTT reagent, dilute PT (small amount of tissue factor [TF]-induced clotting factor IX [FIX] activation; sTF/FIXa), and dilute TT, has been proposed to evaluate physiological or pathological hemostasis. We review routine and modified CWA and their clinical applications. In CWA-sTF/FIXa, elevated peak heights indicate hypercoagulability in patients with cancer or thrombosis, whereas prolonged peak times indicate hypocoagulability in several conditions, including clotting factor deficiency and thrombocytopenia. CWA-dilute TT reflects the thrombin burst, whereas clot-fibrinolysis waveform analysis reflects both hemostasis and fibrinolysis. The relevance and usefulness of CWA-APTT and modified CWA should be further investigated in various diseases.

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“…The key to preventing thromboembolic events is recognizing risk factors that promote thrombus development. Current literature elucidates that the risk of thrombosis is elevated in individuals who have several risk factors, which include but are not limited to, increased age, elevated body mass index, hypercoagulability, family history, smoking, and estrogen therapy [ 3 ]. Plastics and reconstructive surgery, oncological surgery, pelvic surgery, and orthopedic surgery present the highest thrombogenic incidence amongst surgical specialties [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

From Risk Assessment to Intervention: A Systematic Review of Thrombosis in Plastic Surgery

Patel,

Camacho,

Shifchik

et al. 2023

Cureus

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Thromboembolism is a feared complication in plastic surgery and is linked to higher rates of morbidity and mortality. Despite extensive research, there is a lack of consistency between recommendations and clinical protocols to be implemented pre and post-surgery to reduce the incidence of thromboembolism. A systematic literature review was conducted using Pubmed and Scopus databases to determine the risk factors, screening methods, and existing treatment models for thromboembolism prevention. Articles in non-English languages were excluded. Analysis indicated that predominant risk factors include age (>35), elevated body mass index, coagulation disorders, smoking, estrogen therapies, genetic predisposition, vascular endothelium damage, stasis, and use of general anesthesia in patients with a history of cancer. Implementation of a proper prophylactic protocol is dependent on understanding the interplay between the aforementioned risk factors and the utilization of well-defined, evidence-based guidelines, such as the 2005 Caprini Risk Assessment Model and ultrasound surveillance. The literature review revealed that mechanical prophylaxis is the primary prevention method, followed by thromboprophylaxis for patients with higher Caprini scores. Plastic surgeons often underestimate the present risk stratification tools available for the prophylactic intervention of thromboembolism due to the fear of bleeding or hematoma complications postoperatively. In summary, this literature review emphasizes the importance of plastic surgeons selecting protocols that is inclusive of the patient's risk profile to yield a reduced risk of thromboembolism.

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Thromboelastography in Microsurgical Reconstruction: A Systematic Review

Cited by 7 publications

References 24 publications

Detection of a Prethrombotic State in Patients with Hepatocellular Carcinoma, Using a Clot Waveform Analysis

Detection of a Prethrombotic State in Patients with Hepatocellular Carcinoma, Using a Clot Waveform Analysis

Clot Waveform Analysis for Hemostatic Abnormalities

From Risk Assessment to Intervention: A Systematic Review of Thrombosis in Plastic Surgery

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