Use of viscoelastic haemostatic assay in emergency and elective surgery

Yeung, Maximus C F; Tong, Steven Y T; Tong, Paul Y W; Cheung, Billy Ho Hung; Ng, Joanne Yw; Leung, Gilberto Ka Kit

doi:10.12809/hkmj134147

Cited by 15 publications

(16 citation statements)

References 48 publications

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“…TEG has become the reference method for coagulation monitoring during liver transplantation given that it allows a quick and comprehensive evaluation of the multiple components of clot formation whereas traditional tests such as prothrombin time (or INR) and platelet count are unreliable for the evaluation of the coagulation cascade during complex surgery and in patients with cirrhosis. Conventional coagulation tests are also largely ineffective in diagnosing hyperfibrinolysis . Cirrhosis has been variably associated with an increased tendency to fibrinolysis, although contrasting results have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Conventional coagulation tests are also largely ineffective in diagnosing hyperfibrinolysis. 32 Cirrhosis has been variably associated with an increased tendency to fibrinolysis, although contrasting results have been reported. We did not find signs of hyperfibrinolysis in any of the patients, possibly as a result of parallel changes in the circulating levels of proand antifibrinolytic agents.…”

Section: Discussionmentioning

confidence: 99%

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Thrombelastography‐guided blood product use before invasive procedures in cirrhosis with severe coagulopathy: A randomized, controlled trial

et al. 2015

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Bleeding is a feared complication of invasive procedures in patients with cirrhosis and significant coagulopathy (as defined by routine coagulation tests) and is used to justify preprocedure use of fresh frozen plasma (FFP) and/or platelets (PLT). Thromboelastography (TEG) provides a more comprehensive global coagulation assessment than routine tests (international normalized ratio [INR] and platelet count), and its use may avoid unnecessary blood product transfusion in patients with cirrhosis and significant coagulopathy (defined in this study as INR >1.8 and/or platelet count <50 3 10 9 /L) who will be undergoing an invasive procedure. Sixty patients were randomly allocated to TEG-guided transfusion strategy or standard of care (SOC; 1:1 TEG:SOC). The TEG group would receive FFP if the reaction time (r) was >40 min and/or PLT if maximum amplitude (MA) was <30 mm. All SOC patients received FFP and/or PLT per hospital guidelines. Endpoints were blood product use and bleeding complications. Baseline characteristics of the two groups were similar. Per protocol, all subjects in the SOC group received blood product transfusions versus 5 in the TEG group (100% vs. 16.7%; P < 0.0001). Sixteen SOC (53.3%) received FFP, 10 (33.3%) PLT, and 4 (13.3%) both FFP and PLT. In the TEG group, none received FFP alone (P < 0.0001 vs. SOC), 2 received PLT (6.7%; P 5 0.009 vs. SOC), and 3 both FFP and PLT (not significant). Postprocedure bleeding occurred in only 1 patient (SOC group) after large-volume paracentesis. Conclusions: In patients with cirrhosis and significant coagulopathy before invasive procedures, TEG-guided transfusion strategy leads to a significantly lower use of blood products compared to SOC (transfusion guided by INR and platelet count), without an increase in bleeding complications. Remarkably, even in patients with significant coagulopathy, postprocedure bleeding was rare, indicating that TEG thresholds should be reevaluated. (HEPATOLOGY 2016;63:566-573) See Editorial on Page 368 C irrhosis is characterized by decreased synthesis of both procoagulants and anticoagulants, whose delicate balance is further weakened by thrombocytopenia and/or thrombocytopathy.1 These abnormalities result in prolongation of prothrombin time (PT) and of activated partial thromboplastin time (aPTT), all of which have led in the past to consider cirrhosis a prototypical hemorrhagic disorder.2 Consequently, guidelines have recommended the correction of

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Thrombelastography‐guided blood product use before invasive procedures in cirrhosis with severe coagulopathy: A randomized, controlled trial

et al. 2015

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“…[83][84][85] Even though both machines are similar in their measurement technique, they use different activators to standardize the initiation of coagulation, which might explain the difference in the parameters. 86 Consequently, treatment algorithms for the use of transfusion guidance in hemorrhaging trauma patients should be developed separately for both devices. What is more, several variables of VHA measure the same portion of the coagulation cascade as CCTs and show a strong correlation with CCT values.…”

Section: Pitfalls In the Use Of Vha In The Trauma Populationmentioning

confidence: 99%

Viscoelastic Testing in Trauma

Wirtz

Baumann

Klinkspoor

et al. 2017

Semin Thromb Hemost

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Traumatic-induced coagulopathy (TIC) is a complex condition which develops both as a response to trauma as well as to clinical care interventions. Accurate and timely diagnostics are necessary to enable therapy aimed at correction of TIC. Viscoelastic hemostatic assays (VHA) are increasingly recognized for their potential to diagnose TIC as well as for guidance of treatment. This narrative review focuses on the evidence of the use of VHAs to diagnose TIC, to monitor efficacy of treatment of TIC during bleeding and to prognosticate outcome. Pitfalls of the use of VHA are also discussed.

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“…Viscoelastic tests monitor whole-blood coagulation, evaluating clot formation, strength, and lysis or retraction [1], and are the only tests that can provide a rapid diagnosis of hyperfibrinolysis [2]. Performed at the bedside or in the operating theatre by clinical staff, TEG and ROTEM are convenient and provide immediate results.…”

Section: Introductionmentioning

confidence: 99%

Viscoelastic testing for hepatic surgery: a systematic review with meta-analysis—a protocol

et al. 2016

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BackgroundViscoelastic tests, including thromboelastography (TEG) and rotational thromboelastometry (ROTEM), provide a global assessment of haemostatic function at the point of care. The use of a TEG or ROTEM system to guide blood product administration has been shown in some surgical settings to reduce transfusion requirements. The aim of this review is to evaluate all published evidence regarding viscoelastic testing in the setting of hepatic surgery.MethodsWe will search MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials databases to identify randomised controlled trials examining the use of viscoelastic testing for hepatic surgery. Two reviewers will independently screen titles and abstracts of studies identified and will independently extract data. Any disagreements will be resolved by discussion with a third reviewer. A meta-analysis will be conducted if feasible.DiscussionViscoelastic devices such as TEG and ROTEM are increasingly available to clinicians as a bedside test. Patients undergoing hepatic surgery have a significant risk of blood loss and coagulopathy requiring transfusion. Theoretical benefits of use of a TEG or ROTEM system in the hepatic surgical setting include a rationalisation of blood products, a reduction in transfusion-related side effects, an improvement in patient outcomes including mortality, and a reduction in cost. This systematic review will summarise the current evidence regarding the use of viscoelastic testing for hepatic surgery.Systematic review registrationPROSPERO CRD42016036732Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0326-1) contains supplementary material, which is available to authorized users.

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Use of viscoelastic haemostatic assay in emergency and elective surgery

Cited by 15 publications

References 48 publications

Thrombelastography‐guided blood product use before invasive procedures in cirrhosis with severe coagulopathy: A randomized, controlled trial

Thrombelastography‐guided blood product use before invasive procedures in cirrhosis with severe coagulopathy: A randomized, controlled trial

Viscoelastic Testing in Trauma

Viscoelastic testing for hepatic surgery: a systematic review with meta-analysis—a protocol

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