Thromboelastography (TEG®) demonstrates that tinzaparin 4500 international units has no detectable anticoagulant activity after caesarean section

Griffiths, S.; Woo, Chit Shing Jackson; Mansoubi, V.; Riccoboni, A.; Sabharwal, Atika; Napier, Susan; Columb, Malachy O.; Laffan, Michael; Stocks, G.M.

doi:10.1016/j.ijoa.2016.10.001

Cited by 5 publications

(4 citation statements)

References 17 publications

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“…A recent study utilising thromboelastography (TEG) to investigate the effect of prophylactic tinzaparin supports our findings; no detectable anticoagulant effect was seen at 4 to 10 hours following administration (with undetectable anti-Xa activity). 34 An in vitro study investigating the effect of dalteparin in whole blood collected from pregnant women revealed a dose-dependent effect on TEG only when anti-Xa activity was greater than 0.25 U/mL. 28,35 The changes in thrombin generation seen over time in our study compare with that previously reported in women receiving LMWH 12,19 with attenuation of hypercoagulability following first dose of enoxaparin (T3), and further at 1 week postdelivery.…”

Section: Discussionsupporting

confidence: 68%

Mode of Delivery Does Not Influence Postpartum Hypercoagulability Measured by Thrombin Generation or Thromboelastometry

Guimicheva

Roberts

Patel

et al. 2020

TH Open

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Introduction Venous thromboembolism (VTE) is a significant cause of maternal mortality with the greatest risk postpartum. Mode of delivery influences VTE risk, with emergency caesarean section (CS) associated with the highest risk (CS). Thromboprophylaxis is recommended for selected women to reduce the risk of VTE.We aimed to investigate the impact of mode of delivery and thromboprophylaxis on hypercoagulability as measured by thromboelastometry (TEM) and thrombin generation (TG) in women at high VTE risk. Materials and Methods Blood was collected from 99 pregnant women with VTE risk factors at up to five time points from pre- (T1) and post (T2)-delivery to 6 weeks postpartum (T5). Multiple linear regression was utilised to compare TG and TEM between those with vaginal delivery (VD) and CS at each time point. Paired sample t-test with post hoc Bonferroni correction was utilised to compare laboratory markers over time. Results Women in both groups had a median of three postpartum VTE risk factors, with higher body mass index and parity post-VD. In both the groups, TG and TEM parameters suggested hypercoagulability at T2 compared with T1, with resolution at T5. There were minimal differences between groups, apart from T2 with shorter clot formation time and higher maximum clot firmness in the VD group. Conclusion TG and TEM illustrate hypercoagulability associated with pregnancy and delivery. The pattern of postpartum hypercoagulability seen in women with VTE risk factors was similar irrespective of mode of delivery. Further research is required to establish the effect of labour on TG/TEM in the absence of low molecular weight heparin use.

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Section: Discussionsupporting

confidence: 68%

Mode of Delivery Does Not Influence Postpartum Hypercoagulability Measured by Thrombin Generation or Thromboelastometry

Guimicheva

Roberts

Patel

et al. 2020

TH Open

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“…Another area of obstetrics that needs improvement is using TEG/ROTEM to guide thromboprophylaxis. Although TEG is sensitive to the effects of 40 mg enoxaparin 4 hours after administration, it failed to detect the effect of tinzaparin 4500 IU in most pregnant patients 11,116. Future studies need to test TEG or ROTEM with different low molecular weight heparins to determine ideal prophylactic doses to effectively reduce VTE risk after pregnancy.…”

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confidence: 99%

Systematic review of viscoelastic testing (TEG/ROTEM) in obstetrics and recommendations from the women's SSC of the ISTH

Amgalan

Allen

Othman

et al. 2020

Journal of Thrombosis and Haemostasis

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Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are pointof-care viscoelastic devices that use whole blood samples to assess coagulation and fibrinolysis. These devices have been studied extensively in cardiac surgery, but there is limited robust evidence supporting its use in obstetrics. The hesitancy toward its routine use in obstetrics may be due to the current lack of randomized controlled trials and large observational studies. The study aims to systematically review studies that investigated TEG/ROTEM use in pregnancy or peripartum, and to provide recommendations for future studies to fill current research gaps. We performed a systematic review of studies on viscoelastic testing in obstetrics. Included studies were original research, used TEG or ROTEM during pregnancy or peripartum, and published in English. Ninety-three studies, spanning 31 years from 1989 to 2020 and with a total of 32,817 participants, were included. Sixty-two (66.7%) of the studies used TEG and 31 (33.3%) used ROTEM. To date, there are a total of two randomized controlled trials on TEG/ROTEM use in obstetrics. ROTEM may be used to guide transfusion therapy for postpartum hemorrhage. TEG and ROTEM can detect the hypercoagulable changes associated with pregnancy. Variability between study protocols and results suggests the need for future large prospective high-quality studies with standardized protocols to investigate the utility of TEG/ROTEM in assessing risk for thrombosis and hemorrhage as well as in guiding prophylaxis and treatment in obstetric patients. This review identifies the gaps and provides concrete recommendations for future studies to fill those gaps.

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“…Under such circumstances, TEG parameters have been found to be useful in guiding anticoagulation therapy [ 51 ]. But its sensitivity has not been found to be adequate to monitor the progress of anticoagulation [ 10 ]. On the other hand, pregnancy-related complications such as pre-eclampsia and eclampsia reverse the blood coagulability into the hypercoagulable state as well as hemolysis that can be exacerbated during surgery.…”

Section: Reviewmentioning

confidence: 99%

“…This value is similar to extrinsic and intrinsic clotting pathway measurements by PT and aPTT respectively. The R-time largely reflects the adequacy of coagulation factors and is the most sensitive parameter to measure the effects of heparin therapy including low molecular weight heparin (LMWH) [ 10 , 11 ]. An elevated or prolonged R-value (more than eight minutes) can signify a deficiency in clotting factors, hemodilution, or the presence of heparin.…”

Section: Introductionmentioning

confidence: 99%

Thromboelastography in the Perioperative Period: A Literature Review

Ramanujam¹,

DiMaria²,

Varma³

2023

Cureus

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Assessing coagulation status is essential for prompt intervention to reduce morbidity and mortality related to bleeding and thrombotic complications during the perioperative period. Traditional coagulation tests such as platelet count, activated partial thromboplastin time (aPTT), prothrombin time (PT), international normalized ratio (INR), and activated clotting time (ACT) provide only static evaluation. These tests are not designed for assessment of dynamically changing coagulation conditions during the perioperative time. However, viscoelastic coagulation testing such as thromboelastography (TEG) produces a rapid numerical and graphical representation that helps to detect and direct targeted hemostatic therapy. Searching the literature through PubMed, Medline, Ovid, CINAHL, and ClinicalTrials.gov we retrieved 210 studies, which represent the use of TEG in the perioperative period. The included studies were categorized under various settings such as trauma, obstetrics, orthopedics, intensive care unit (ICU), cardiovascular, transplant, and miscellaneous scenarios. TEG showed promising results in trauma surgeries in predicting mortality, hypercoagulability, and bleeding even when it was compared to conventional methods. TEG was also useful in monitoring anticoagulant therapy in orthopedic and obstetric surgeries; however, its role in predicting thrombotic events, hypercoagulability, or complications was questionable. In ICU patients, it showed promising results, especially in the prediction or improvement of sepsis, coagulopathy, thrombotic events, ICU duration, hospital stay, and ventilator duration. TEG parameters effectively predicted hypercoagulation in transplant surgeries. Regarding cardiovascular surgeries, they were effective in the prediction of the need for blood products, coagulopathy, thrombotic events, and monitoring anticoagulation therapy. More randomized clinical trials comparing TEG parameters with standardized tools are needed to produce robust results to standardize its use in different perioperative settings.

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Thromboelastography (TEG®) demonstrates that tinzaparin 4500 international units has no detectable anticoagulant activity after caesarean section

Cited by 5 publications

References 17 publications

Mode of Delivery Does Not Influence Postpartum Hypercoagulability Measured by Thrombin Generation or Thromboelastometry

Mode of Delivery Does Not Influence Postpartum Hypercoagulability Measured by Thrombin Generation or Thromboelastometry

Systematic review of viscoelastic testing (TEG/ROTEM) in obstetrics and recommendations from the women's SSC of the ISTH

Thromboelastography in the Perioperative Period: A Literature Review

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