BACKGROUND: Several methods exist for evaluation of hypocoagulation in patients with perioperative bleeding, e.g. thromboelastography (TEG(®)) and conventional methods (platelet count, aPTT, INR and fibrinogen). Considering the vast experience of conventional methods it is important to investigate how well the methods correspond. METHODS: Sixty surgical patients were included prospectively and blood samples were taken perioperatively. TEG(®) and conventional parameters were analyzed simultaneously. An assessment of coagulopathy, based on a synthesis of the conventional methods, was done by two experienced coagulation specialists, blinded from the results of TEG(®) and from the results of each other. Hypocoagulation, defined by TEG(®) parameters; reaction time (R-time), angle, maximal amplitude (MA) and fibrinolysis, was evaluated according to a commonly used algorithm. RESULTS: To detect a platelet count below 150 × 10(9) L(-1), the sensitivity of TEG was 17% (95% CI, 7-36%) with angle and 25% (95% CI, 11-45%) with MA. The sensitivity to detect fibrinogen below 2 g/L was 11% (95% CI, 3-29%) with angle and 21% with MA (95% CI, 8-43%). To detect aPTT more than 40 s and INR more than 1.2 with R-time, the sensitivity was 19% (95% CI, 8-37%) and 0% (95% CI, 0-69%) respectively. The agreement of the evaluator's assessments of hypocoagulation was 100%, but the agreement with the overall TEG(®) analysis was poor with a sensitivity of 33% and a specificity of 95%. CONCLUSION: The agreement between conventional laboratory tests and TEG is poor, but it remains uncertain which type of coagulation tests that best reflects the actual bleeding risk.
BACKGROUND: Several methods exist for evaluation of hypocoagulation in patients with perioperative bleeding, e.g. thromboelastography (TEG(®)) and conventional methods (platelet count, aPTT, INR and fibrinogen). Considering the vast experience of conventional methods it is important to investigate how well the methods correspond. METHODS: Sixty surgical patients were included prospectively and blood samples were taken perioperatively. TEG(®) and conventional parameters were analyzed simultaneously. An assessment of coagulopathy, based on a synthesis of the conventional methods, was done by two experienced coagulation specialists, blinded from the results of TEG(®) and from the results of each other. Hypocoagulation, defined by TEG(®) parameters; reaction time (R-time), angle, maximal amplitude (MA) and fibrinolysis, was evaluated according to a commonly used algorithm. RESULTS: To detect a platelet count below 150 × 10(9) L(-1), the sensitivity of TEG was 17% (95% CI, 7-36%) with angle and 25% (95% CI, 11-45%) with MA. The sensitivity to detect fibrinogen below 2 g/L was 11% (95% CI, 3-29%) with angle and 21% with MA (95% CI, 8-43%). To detect aPTT more than 40 s and INR more than 1.2 with R-time, the sensitivity was 19% (95% CI, 8-37%) and 0% (95% CI, 0-69%) respectively. The agreement of the evaluator's assessments of hypocoagulation was 100%, but the agreement with the overall TEG(®) analysis was poor with a sensitivity of 33% and a specificity of 95%. CONCLUSION: The agreement between conventional laboratory tests and TEG is poor, but it remains uncertain which type of coagulation tests that best reflects the actual bleeding risk.
Authors: Alex Gatt; Fabian Bonello; Raphael Buttigieg; Samuel Debono; Patricia Brincat; Charlie Grima; Peter Gatt; Thomas Lofaro; Stefan Laspina Journal: Blood Transfus Date: 2014-06-05 Impact factor: 3.443
Authors: Michael D Goodman; Amy T Makley; Dennis J Hanseman; Timothy A Pritts; Bryce R H Robinson Journal: J Trauma Acute Care Surg Date: 2015-07 Impact factor: 3.313
Authors: Rolf Rossaint; Bertil Bouillon; Vladimir Cerny; Timothy J Coats; Jacques Duranteau; Enrique Fernández-Mondéjar; Daniela Filipescu; Beverley J Hunt; Radko Komadina; Giuseppe Nardi; Edmund A M Neugebauer; Yves Ozier; Louis Riddez; Arthur Schultz; Jean-Louis Vincent; Donat R Spahn Journal: Crit Care Date: 2016-04-12 Impact factor: 9.097