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Vollmer NJ, Leshko NA, Wilson CS, Gilbert BW. A Review of Thromboelastography for Nurses. Crit Care Nurse 2023; 43:29-37. [PMID: 37257875 DOI: 10.4037/ccn2023371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Thromboelastography is a viscoelastic test with multiple potential advantages over conventional coagulation tests in various disease states. Thromboelastography rapidly provides qualitative and quantitative information related to a patient's coagulation status. OBJECTIVE To describe recent studies of the use of thromboelastography in various clinical states and how thromboelastography is used in coagulation management. METHODS A literature review using the MEDLINE and PubMed databases was conducted. The updated methodology for integrated reviews by Whittemore and Knafl was followed. Coauthors evaluated separate areas that were independently reviewed by other coauthors to ensure appropriateness for inclusion. RESULTS The use of thromboelastography for various clinical conditions with challenging hemostatic profiles has increased. This integrative review covers the use of thromboelastography in patients with trauma, medication-induced coagulopathy, acute and chronic liver failure, and cardiothoracic surgery. Potential future directions are also discussed. DISCUSSION Thromboelastography has numerous potential benefits over conventional coagulation tests for assessing coagulation status in patients in various clinical states. Nurses can support clinical decisions to use the most appropriate test for their patients. CONCLUSIONS Each team member should be involved in assessing the usefulness of thromboelastography. Critical care nurses and the multidisciplinary team must identify patients in whom its use is warranted, interpret the results, and provide appropriate interventions in response to the results and clinical status of the patient.
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Affiliation(s)
- Nicholas J Vollmer
- Nicholas J. Vollmer is an emergency medicine and intensive care unit clinical pharmacy specialist at Mayo Clinic, Rochester, Minnesota
| | - Nicole A Leshko
- Nicole A. Leshko is a critical care pharmacist at Northwestern Memorial Hospital, Chicago, Illinois
| | - Charles S Wilson
- Charles S. Wilson Jr is a postgraduate year 2 critical care pharmacy resident at Wesley Medical Center, Wichita, Kansas
| | - Brian W Gilbert
- Brian W. Gilbert is an emergency medicine clinical pharmacy specialist and Residency Program Director for the Postgraduate Year 2 Critical Care Pharmacy program at Wesley Medical Center
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Schroeder JA, Kuether EA, Fang J, Jing W, Weiler H, Wilcox DA, Montgomery RR, Shi Q. Thromboelastometry assessment of hemostatic properties in various murine models with coagulopathy and the effect of factor VIII therapeutics. J Thromb Haemost 2021; 19:2417-2427. [PMID: 34245090 PMCID: PMC8865566 DOI: 10.1111/jth.15456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/07/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Rotational thromboelastometry (ROTEM) has been commonly used to assess the viscoelastic properties of the blood clotting process in the clinic for patients with a hemostatic or prothrombotic disorder. OBJECTIVE To evaluate the capability of ROTEM in assessing hemostatic properties in whole blood from various mouse models with genetic bleeding or clotting disease and the effect of factor VIII (FVIII) therapeutics in FVIIInull mice. METHODS Mice with a genetic deficiency in either a coagulation factor or a platelet glycoprotein were used in this study. The properties of platelet- or plasma-FVIII were also assessed. Citrated blood from mice was recalcified and used for ROTEM analysis. RESULTS We found that blood collected from the vena cava could generate reliable results from ROTEM analysis, but not blood collected from the tail vein, retro-orbital plexus, or submandibular vein. Age and sex did not significantly affect the hemostatic properties determined by ROTEM analysis. Clotting time (CT) and clot formation time (CFT) were significantly prolonged in FVIIInull (5- and 9-fold, respectively) and FIXnull (4- and 5.7-fold, respectively) mice compared to wild-type (WT)-C57BL/6J mice. Platelet glycoprotein (GP)IIIanull mice had significantly prolonged CFT (8.4-fold) compared to WT-C57BL/6J mice. CT and CFT in factor V (FV) Leiden mice were significantly shortened with an increased α-angle compared to WT-C57BL/6J mice. Using ROTEM analysis, we showed that FVIII expressed in platelets or infused into whole blood restored hemostasis of FVIIInull mice in a dose-dependent manner. CONCLUSION ROTEM is a reliable and sensitive assay for assessing therapeutics on hemostatic properties in mouse models with a bleeding or clotting disorder.
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Affiliation(s)
- Jocelyn A. Schroeder
- Blood Research Institute, Versiti Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Children’s Research Institute, Children’s Wisconsin, Milwaukee, Wisconsin, USA
- MACC Fund Research Center, Milwaukee, Wisconsin, USA
| | - Erin A. Kuether
- Blood Research Institute, Versiti Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Children’s Research Institute, Children’s Wisconsin, Milwaukee, Wisconsin, USA
- MACC Fund Research Center, Milwaukee, Wisconsin, USA
| | - Juan Fang
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- MACC Fund Research Center, Milwaukee, Wisconsin, USA
| | - Weiqing Jing
- Blood Research Institute, Versiti Wisconsin, Milwaukee, Wisconsin, USA
| | - Hartmut Weiler
- Blood Research Institute, Versiti Wisconsin, Milwaukee, Wisconsin, USA
| | - David A. Wilcox
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Children’s Research Institute, Children’s Wisconsin, Milwaukee, Wisconsin, USA
- MACC Fund Research Center, Milwaukee, Wisconsin, USA
| | - Robert R. Montgomery
- Blood Research Institute, Versiti Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Children’s Research Institute, Children’s Wisconsin, Milwaukee, Wisconsin, USA
- MACC Fund Research Center, Milwaukee, Wisconsin, USA
| | - Qizhen Shi
- Blood Research Institute, Versiti Wisconsin, Milwaukee, Wisconsin, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Children’s Research Institute, Children’s Wisconsin, Milwaukee, Wisconsin, USA
- MACC Fund Research Center, Milwaukee, Wisconsin, USA
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Visweshwar N, Jaglal M, Patel A, Laber D, Sokol L. Should we integrate viscoelastic assays with standard coagulation screening? J Clin Pathol 2021; 74:141-143. [PMID: 33436484 DOI: 10.1136/jclinpath-2020-207099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Nathan Visweshwar
- Department of Hematology, University of South Florida, Tampa, Florida, USA
| | - Michael Jaglal
- Department of Hematology/Oncology, Tampa General Hospital, Tampa, Florida, USA
| | - Ankita Patel
- Department of Hematology/Oncology, Tampa General Hospital, Tampa, Florida, USA
| | - Damian Laber
- Department of Hematology/Oncology, Tampa General Hospital, Tampa, Florida, USA
| | - Lubomir Sokol
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida, USA
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Tuovila M, Erkinaro T, Takala H, Savolainen ER, Laurila P, Ohtonen P, Ala-Kokko T. Hyperthermic intraperitoneal chemotherapy enhances blood coagulation perioperatively evaluated by thromboelastography: a pilot study. Int J Hyperthermia 2020; 37:293-300. [PMID: 32208777 DOI: 10.1080/02656736.2020.1742389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background and Objectives: Postoperative thromboembolism is a significant cause of prolonged recovery in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Thromboelastography (TEG) can detect hypercoagulable states and predict thromboembolic complications after surgery. This study assessed the impact of CRS and HIPEC on TEG values.Methods: TEG parameters reaction time (R), kinetics time (K), angle (α), maximum amplitude (MA), and lysis percent at 60 min (LY60) were determined preoperatively, and at the end of CRS, during HIPEC, and at the end of the operation using blood samples from 15 HIPEC patients. Platelets, P-TT, and aPTT were also determined before and after CRS.Results: A total of 75 samples were analyzed. During CRS, there was a significant reduction in the mean MA (3.06 mm, p = 0.001). The mean P-TT declined by 32% (p < 0.001) and mean platelets by 55 × 109/L (p < 0.001). During HIPEC, the mean R and K shortened by 1.04 min (p = 0.015) and 0.18 min (p = 0.018), respectively, whereas α increased by 2.48° (p = 0.005).Conclusions: During CRS, both TEG and conventional laboratory tests indicated hypocoagulation. During HIPEC, however, the initiation of coagulation and the kinetics of thrombin formation were accelerated.
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Affiliation(s)
- Mari Tuovila
- Department of Anesthesiology, Division of Intensive Care, Oulu University Hospital, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Tiina Erkinaro
- Department of Anesthesiology, Division of Intensive Care, Oulu University Hospital, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Heikki Takala
- Division of Operative Care, Oulu University Hospital and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Eeva-Riitta Savolainen
- Nordlab Oulu Hematology Laboratory, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Päivi Laurila
- Department of Anesthesiology, Division of Intensive Care, Oulu University Hospital, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Pasi Ohtonen
- Division of Operative Care, Oulu University Hospital and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Tero Ala-Kokko
- Department of Anesthesiology, Division of Intensive Care, Oulu University Hospital, Medical Research Center Oulu, University of Oulu, Oulu, Finland
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5
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Thromboelastography testing in mice following blood collection from facial vein and cardiac puncture. Blood Coagul Fibrinolysis 2020; 30:366-369. [PMID: 31318718 DOI: 10.1097/mbc.0000000000000836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
: Blood collection is critical for mouse research studies particularly in hemostatic testing. Cardiac puncture; a standard effective method requires anesthesia and is a terminal procedure while facial vein technique allows multiple collections. Thromboelastography (TEG) is a global hemostasis test, provides a dynamic real-time picture of coagulation. However, TEG experiments in mice require large number of animals and may not allow pre/postinterventions assessment. In this study, we aimed to investigate the feasibility of facial vein sampling for TEG analysis as an alternative to cardiac puncture and examined the impact on coagulation results. Blood samples were obtained from a total of 10 C57BL/6 and CD-1 mice via cardiac puncture and a total of another eight mice of similar strains via facial vein sampling. We compared TEG parameters in both methods using descriptive statistics and the Student t test. Results show no significant difference in any of the TEG parameters between cardiac and facial vein blood indicating the two methods are comparable. Facial vein sampling provides a less costly alternative to cardiac puncture. It is a suitable blood collection method for pre/postinterventions or follow-up studies and it better addresses reduction and refinement goals in mouse studies. A larger study to evaluate the sex or strain and genetic background differences will be valuable.
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Zhou Q, Mao M, Meng J, Shi K, Lin J, Lu Q. The thromboelastography G parameter as a potential biomarker of acute coronary syndrome. Scandinavian Journal of Clinical and Laboratory Investigation 2020; 80:196-201. [PMID: 31899967 DOI: 10.1080/00365513.2019.1709986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The most prominent event that defines acute coronary syndrome (ACS) is the formation of an intra-arterial thrombus, usually resulting from activation of platelet and fibrinogen at the ruptured plaque. Usually, conventional coagulation tests (CCTs) are used to estimate the hemostatic properties of patients. However, CCTs have significant limitations because they each assess individual aspects of the coagulation cascade, which is a complex multifaceted process. And CCTs are performed with platelet-poor plasma, while the contribution of platelets to clot formation is not measured. In contrast, thromboelastography (TEG) is a test for global hemostasis with whole blood, from the beginning of coagulation through clot formation to the ending with fibrinolysis. The aim of this study was to investigate whether TEG parameters could be surrogate biomarkers of thrombus formation process and diagnosis of ACS. Receiver operating characteristic(ROC)curve was used to evaluate the diagnosis performance of each index. Logistic regression analysis was utilized to define the independent risk factors of ACS. The results showed that the shear elastic modulus parameter (G) was an independent diagnostic indicator for ACS (odds ratio [OR], 2.600; 95% confidence interval [CI], 2.035-3.322). The area under ROC curve of G was 0.866. The optimal cut-off value for the diagnosis of ACS was 10.55 dyne/cm2, while the sensitivity was 66.2% and the specificity was 92.4%. In conclusion, G could be used as an optimal indicator of activation of platelet and fibrinogen, which is eligible to be a useful biomarker for early diagnosis of ACS.
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Affiliation(s)
- Qingfen Zhou
- Department of Cardiology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Minjing Mao
- Department of Clinical Laboratory, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jun Meng
- Department of Clinical Laboratory, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kaifeng Shi
- Department of Clinical Laboratory, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jing Lin
- Department of Clinical Laboratory, Xinrui Hospital, Wuxi, China
| | - Qiuya Lu
- Department of Clinical Laboratory, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Ahammad J, Kurien A, Shastry S, Shah HH, Nayak D, Kamath A, Badagabettu S. Age‐ and gender‐related reference ranges for thromboelastography from a healthy Indian population. Int J Lab Hematol 2019; 42:180-189. [DOI: 10.1111/ijlh.13148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/18/2019] [Accepted: 12/04/2019] [Indexed: 01/21/2023]
Affiliation(s)
- Javed Ahammad
- Melaka Manipal Medical College Manipal Academy of Higher Education Manipal India
| | - Annamma Kurien
- Melaka Manipal Medical College Manipal Academy of Higher Education Manipal India
| | - Shamee Shastry
- Kasturba Medical College Manipal Academy of Higher Education Manipal India
| | - Hitesh H. Shah
- Kasturba Medical College Manipal Academy of Higher Education Manipal India
| | - Dinesh Nayak
- Melaka Manipal Medical College Manipal Academy of Higher Education Manipal India
| | - Asha Kamath
- Department of Statistics Manipal Academy of Higher Education Manipal India
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Ghirardello S, Raffaeli G, Scalambrino E, Chantarangkul V, Cavallaro G, Artoni A, Mosca F, Tripodi A. The intra-assay reproducibility of thromboelastography in very low birth weight infants. Early Hum Dev 2018; 127:48-52. [PMID: 30312859 DOI: 10.1016/j.earlhumdev.2018.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/26/2018] [Accepted: 10/04/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Despite the potential benefits of thromboelastography (TEG) for bedside hemostatic assessment in critical care settings, its accuracy remains to be determined, especially in critically ill neonates. We determined the intra-assay reproducibility of TEG parameters: Reaction time (R), clot kinetics (K) and Maximum Amplitude (MA) in a cohort of very low birth weight (VLBW) infants. STUDY DESIGN Observational study. SUBJECTS One hundred VLBW newborns. OUTCOME MEASURES We performed TEG duplicate measurements for blood samples from VLBW newborns. To assess for correlation, we calculated the coefficients of correlation by plotting the values of the first vs the second measurement. Paired samples were compared with t-test and the coefficient of variation (CV) on paired results was also calculated as a measure of variability. To evaluate the agreement between duplicates, Bland-Altman (BA) analysis was performed. RESULTS We evaluated 228 TEG pairs. Both the coefficient of correlation and the BA analysis showed an acceptable level of agreement between duplicates. TEG variability (CV, mean ± SD) was highest for K (10.4%, ±12.9), lowest for MA (3.6%, ±8.0) and moderate for R (7.9%, ±9.0). The results from ANOVA one-way analysis describe different variability trends: K-CV increased at higher values, while MA-CV and R-CV increased at lower values. CONCLUSIONS In VLBW newborns, the agreement between TEG duplicate measurements for R and MA parameters is adequate for clinical purposes. TEG is a promising tool to quickly assess hemostasis ensuring a significant blood sparing in critically ill neonates.
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Affiliation(s)
- Stefano Ghirardello
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy.
| | - Genny Raffaeli
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy
| | - Erica Scalambrino
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
| | - Veena Chantarangkul
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy
| | - Giacomo Cavallaro
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy.
| | - Andrea Artoni
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy.
| | - Fabio Mosca
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy.
| | - Armando Tripodi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Italy.
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Liu W, Yang X, Li N, Xi G, Wang M, Liang B, Feng Y, Chen H, Shi C, Li W. Genipin crosslinked microspheres as an effective hemostatic agent. POLYM ADVAN TECHNOL 2018. [DOI: 10.1002/pat.4377] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Wen Liu
- Wenzhou Institute of Biomaterials and Engineering; CNITECH, CAS; Wenzhou Zhejiang 325011 China
- School of Ophthalmology and Optometry, Eye Hospital, School of Biomedical Engineering; Wenzhou Medical University; Wenzhou Zhejiang 325011 China
| | - Xiao Yang
- Wenzhou Institute of Biomaterials and Engineering; CNITECH, CAS; Wenzhou Zhejiang 325011 China
- School of Ophthalmology and Optometry, Eye Hospital, School of Biomedical Engineering; Wenzhou Medical University; Wenzhou Zhejiang 325011 China
- School of Chemical Engineering and Technology, Collaborative Innovation Center of Chemical Science and Chemical Engineering (Tianjin); Tianjin University; Tianjin 300072 China
| | - Na Li
- Wenzhou Institute of Biomaterials and Engineering; CNITECH, CAS; Wenzhou Zhejiang 325011 China
- School of Ophthalmology and Optometry, Eye Hospital, School of Biomedical Engineering; Wenzhou Medical University; Wenzhou Zhejiang 325011 China
| | - Guanghui Xi
- Wenzhou Institute of Biomaterials and Engineering; CNITECH, CAS; Wenzhou Zhejiang 325011 China
- School of Ophthalmology and Optometry, Eye Hospital, School of Biomedical Engineering; Wenzhou Medical University; Wenzhou Zhejiang 325011 China
| | - Mingshan Wang
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou Medical University; Wenzhou Zhejiang 325000 China
| | - Bin Liang
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou Medical University; Wenzhou Zhejiang 325000 China
| | - Yakai Feng
- Wenzhou Institute of Biomaterials and Engineering; CNITECH, CAS; Wenzhou Zhejiang 325011 China
- School of Ophthalmology and Optometry, Eye Hospital, School of Biomedical Engineering; Wenzhou Medical University; Wenzhou Zhejiang 325011 China
- School of Chemical Engineering and Technology, Collaborative Innovation Center of Chemical Science and Chemical Engineering (Tianjin); Tianjin University; Tianjin 300072 China
| | - Hao Chen
- Wenzhou Institute of Biomaterials and Engineering; CNITECH, CAS; Wenzhou Zhejiang 325011 China
- School of Ophthalmology and Optometry, Eye Hospital, School of Biomedical Engineering; Wenzhou Medical University; Wenzhou Zhejiang 325011 China
| | - Changcan Shi
- Wenzhou Institute of Biomaterials and Engineering; CNITECH, CAS; Wenzhou Zhejiang 325011 China
- School of Ophthalmology and Optometry, Eye Hospital, School of Biomedical Engineering; Wenzhou Medical University; Wenzhou Zhejiang 325011 China
| | - Wenzhong Li
- Institut für Chemie und Biochemie; Freie Universität Berlin; Takustrasse 3, 14195 Berlin Germany
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Tien H, Peng HT, Nascimento B, Callum J, Rhind SG, Beckett A. A Comparative Analysis of Functional Fibrinogen Assays using TEG and ROTEM in Trauma Patients Enrolled in the FiiRST Trial. ACTA ACUST UNITED AC 2018. [DOI: 10.5005/jp-journals-10030-1217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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van Wessem KJP, Leenen LPH. Thromboelastography does not provide additional information to guide resuscitation in the severely injured. ANZ J Surg 2017; 88:697-701. [PMID: 29266754 DOI: 10.1111/ans.14357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/23/2017] [Accepted: 11/09/2017] [Indexed: 12/29/2022]
Abstract
BackgroundHaemostasis assessment is essential to determine the early need for massive transfusion in the treatment of polytrauma. Strategies to guide correction of coagulopathy vary widely. In order to evaluate thromboelastography (TEG) for this goal, a prospective study was performed comparing TEG to conventional coagulation assays (CCAs) in severely injured patients.MethodsConsecutive polytrauma patients admitted to the intensive care unit of a level‐1 trauma centre were prospectively included over a 30‐month period. All patients had CCA on arrival in emergency department. Patients who needed massive transfusion and underwent urgent surgery had additionally a Kaolin‐activated TEG.ResultsOne hundred and thirty‐five patients were included, 76% male, median age 45 years, 96% blunt injuries and median injury severity score was 29. One hundred and fourteen patients had CCA only and 21 patients had both CCA and TEG. Patients who had both CCA and TEG were acidotic, hypothermic and coagulopathic on arrival in emergency department. All 21 patients had normal TEG results even though prothrombin time was prolonged.ConclusionsTEGs were normal in all polytrauma patients even though patients were severely injured. They had prolonged prothrombin time, acidosis and hypothermia both on arrival and when TEG was measured. Caution should be exercised in interpretation of TEG results in treating polytrauma patients. In our system, with aggressive early haemostatic resuscitation, TEG does not provide additional information in guiding resuscitation.
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Affiliation(s)
- Karlijn J P van Wessem
- Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Luke P H Leenen
- Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
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12
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In-vitro assessment of the effect of dabigatran on thrombosis of adult and neonatal plasma. Blood Coagul Fibrinolysis 2017; 28:551-557. [DOI: 10.1097/mbc.0000000000000639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Thane K, Bedenice D, Pacheco A. Operator-based variability of equine thromboelastography. J Vet Emerg Crit Care (San Antonio) 2017; 27:419-424. [PMID: 28520166 DOI: 10.1111/vec.12610] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 10/29/2015] [Accepted: 11/18/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the extent of intraoperator (between duplicate samples) and interoperator (between different operators) variability in equine thromboelastography (TEG). DESIGN Kaolin-activated TEG was performed in duplicate by operator-pair A/B or A/C (2 groups of 10 horses) using discrete setups, within 30-45 minutes of vacuum-assisted blood collection. Recorded TEG variables included clot initiation time (R), clot formation time (K), rate of clot formation (α), clot strength (MA), and viscoelastic/shear strength (G). Operators independently determined the clinical coagulation status for each sample. Intra- and interoperator variabilities were reported as coefficients of variation (CV), using descriptive statistics and paired samples t-test or Wilcoxon matched pair signed-rank test (P < 0.05 considered significant). ANIMALS Twenty hospitalized adult horses with no clinical evidence of systemic inflammation. MEASUREMENTS AND MAIN RESULTS Mean intraoperator CVs ranged from 2.6 to 14% (operator A), 2.8 to 13% (operator B) and 1.2 to 18% (operator C). Both intra- and interoperator variabilities were lowest for MA (1.2-3.2%) and G (2.9-7.3%), and highest for K (13-23%). Mean CVs for all TEG parameters were lower when comparing intra- to interoperator variation. Seventy percent of horses had at least 1 TEG variable (out of 4 replicates) outside the established reference intervals. Assessment of coagulation status was conserved between operators in 9/10 and 8/10 horses for A/B and A/C, respectively, with comparable agreement between operator A/B (к = 0.73) and A/C (к = 0.74). CONCLUSIONS TEG measurements of MA and G are more reproducible than assessment of K, within samples and between operators. The highest test variability was thus observed within the early phase of clot formation.
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Affiliation(s)
- Kristen Thane
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, 01536
| | - Daniela Bedenice
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, 01536
| | - Ana Pacheco
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, 01536.,Dr.'s Pacheco current address: Genesee Valley Equine Clinic, Scottsville, NY
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Preoperative Thromboelastography as a Sensitive Tool Predicting Those at Risk of Developing Early Hepatic Artery Thrombosis After Adult Liver Transplantation. Transplantation 2017; 100:2382-2390. [PMID: 27780186 DOI: 10.1097/tp.0000000000001395] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Whilst causes of hepatic artery thrombosis (HAT) after liver transplantation (LT) are multifactorial, early HAT (E-HAT) remains pertinent complication impacting on graft and patient survival. Currently there is no screening tool that would identify patients with increased risk of developing E-HAT. METHODS We analyzed the native procoagulant state of LT recipients, identified through pretransplant thromboelastographic (TEG) data among other known risk factors, to identify risk factors for E-HAT. RESULTS The outcomes of 828 adult patients undergoing LT between 2008 and 2013 were analyzed. Overall, 79 (9.5%) patients experienced HAT, E-HAT was diagnosed in 23, and in the remainder this was "late" HAT. The maximum amplitude (MA) on preoperative TEG was significantly higher in patients diagnosed with E-HAT compared with those who did not (71.2 mm vs 57.9 mm; P < 0.0001). Receiver operating characteristic analysis with the cutoff value for MA of 65 mm or greater returned area under the curve of 0.750 (P < 0.001) predicting E-HAT with a sensitivity of 70%. A total of 7% of patients with an MA of 65 mm or greater went on to develop E-HAT (hazard ratio, 5.28; 95% confidence interval, 2.10-12.29; P < 0.001), whereas only 1.2% patients with an MA less than 65 mm experienced E-HAT. CONCLUSIONS Preoperative TEG may reliably identify group of recipients at greater risk of developing E-HAT, and intense surveillance and anticoagulation prophylaxis may avoid this serious complication after LT.
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Abstract
Viscoelastic assays, such as thrombelastography (TEG) and rotational thrombelastometry (ROTEM), have emerged as point-of-care tools that can guide the hemostatic resuscitation of bleeding injured patients. This article describes the role of TEG in contemporary trauma care by explaining this assay's methodology, clinical applications, and result interpretation through description of supporting studies to provide the reader with an evidence-based user's guide. Although TEG and ROTEM are assays based on the same viscoelastic principle, this article is focused on data supporting the use of TEG in trauma, because it is available in trauma centers in North America; ROTEM is mostly available in Europe.
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Dias JD, Haney EI, Mathew BA, Lopez-Espina CG, Orr AW, Popovsky MA. New-Generation Thromboelastography: Comprehensive Evaluation of Citrated and Heparinized Blood Sample Storage Effect on Clot-Forming Variables. Arch Pathol Lab Med 2017; 141:569-577. [DOI: 10.5858/arpa.2016-0088-oa] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Thromboelastography (TEG) is a whole blood, real-time analyzer measuring the viscoelastic properties of the hemostasis process and allowing for individualized goal-directed therapy. However, routine use of TEG requires validation of sample storage effect on clot parameters.
Objectives.—
To establish the minimum time required for equilibration time and the maximum time for sample storage for all commercially available TEG tests for the new-generation TEG 6s and to determine how those times compare with the older generation TEG 5000.
Design.—
Citrated and heparinized whole blood samples obtained from 20 healthy donors were analyzed for clot parameters at multiple time points for both the TEG 6s and the TEG 5000. Samples were activated with the citrated multichannel cartridge or the platelet-mapping cartridge in the TEG 6s or with recalcified kaolin in the TEG 5000.
Results.—
All blood samples yielded TEG parameter results within reference ranges and had a tendency toward hypercoagulable profiles with increased storage time. Sample storage resulted in increased platelet inhibition with significant differences at 4 hours in the platelet-mapping cartridge (arachidonic acid percentage of inhibition, P = .002; adenosine diphosphate percentage of inhibition, P = .02).
Conclusions.—
For nonemergent cases or in a central laboratory setting, all tests provided reliable results for up to 4 hours in the citrated multichannel cartridge and for 3 hours for platelet function information in the platelet-mapping cartridge. In emergent/urgent situations in which the sample needs to be run immediately, RapidTEG and functional fibrinogen tests may be preferred.
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Affiliation(s)
| | | | | | | | | | - Mark A. Popovsky
- From the Department of Clinical Marketing, Haemonetics SA, Signy, Switzerland (Dr Dias); the Department of Scientific Research & Development, Haemonetics Corporation, Rosemont, Illinois (Mss Haney and Mathew and Mr Lopez-Espina); and the Department of Medical & Clinical Affairs, Haemonetics Corporation, Braintree, Massachusetts (Mr Orr and Dr Popovsky). Mr Orr is now with Anika Therapeutics Inc,
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Schoergenhofer C, Buchtele N, Schwameis M, Bartko J, Jilma B, Jilma-Stohlawetz P. The use of frozen plasma samples in thromboelastometry. Clin Exp Med 2017; 17:489-497. [PMID: 28210886 PMCID: PMC5653723 DOI: 10.1007/s10238-017-0454-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/19/2017] [Indexed: 12/11/2022]
Abstract
Thromboelastometry is increasingly used in the clinical and scientific setting. The use of frozen plasma samples may be useful in overcoming certain limitations such as local and timely availability. Whole blood (WB) samples of 20 healthy volunteers were obtained, and plasma was generated. NATEM (n = 20), EXTEM (n = 20) and INTEM (n = 8) analyses were performed in WB, fresh plasma and frozen and thawed plasma. Dabigatran (500, 1000 ng/ml), rivaroxaban (100, 200 ng/ml) or alteplase (333 ng/ml) were added ex vivo to WB, and thromboelastometry was performed in WB and in frozen and thawed plasma samples. Clot formation time, mean clot firmness and the area under the curve were significantly altered in plasma compared to WB. In INTEM and EXTEM analysis, clotting time (CT) was comparable between WB (100%) and fresh (INTEM 114% and EXTEM 93%, ratio of the means) and frozen plasma samples (85 and 99%), whereas in NATEM analysis, the CT increased in fresh (193%) and frozen plasma samples (130%). Dabigatran dose-dependently increased the CT approximately 5- and 9-fold in WB and even more pronounced 10- and 26-fold in plasma. Accordingly, rivaroxaban dose-dependently increased the CT 2- and 2.7-fold in WB, and 3.5- and 4-fold in plasma samples. Hyperfibrinolysis was achieved by addition of alteplase in all WB samples and was reproducible in plasma samples. In conclusion, thromboelastometry, especially INTEM and EXTEM analyses, is possible using frozen and stored plasma samples with comparable results to the corresponding whole blood samples.
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Affiliation(s)
- Christian Schoergenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Nina Buchtele
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Schwameis
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Johann Bartko
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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De Pietri L, Bianchini M, Rompianesi G, Bertellini E, Begliomini B. Thromboelastographic reference ranges for a cirrhotic patient population undergoing liver transplantation. World J Transplant 2016; 6:583-593. [PMID: 27683637 PMCID: PMC5036128 DOI: 10.5500/wjt.v6.i3.583] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 06/21/2016] [Accepted: 08/16/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To describe the thromboelastography (TEG) “reference” values within a population of liver transplant (LT) candidates that underline the differences from healthy patients.
METHODS Between 2000 and 2013, 261 liver transplant patients with a model for end-stage liver disease (MELD) score between 15 and 40 were studied. In particular the adult patients (aged 18-70 years) underwent to a first LT with a MELD score between 15 and 40 were included, while all patients with acute liver failure, congenital bleeding disorders, and anticoagulant and/or antiplatelet drug use were excluded. In this population of cirrhotic patients, preoperative haematological and coagulation laboratory tests were collected, and the pretransplant thromboelastographic parameters were studied and compared with the parameters measured in a previously studied population of 40 healthy subjects. The basal TEG parameters analysed in the cirrhotic population of liver candidates were as follows: Reaction time (r), coagulation time (k), Angle-Rate of polymerization of clot (αAngle), Maximum strenght of clot (MA), Amplitudes of the TEG tracing at 30 min and 60 min after MA is measured (A30 and A60), and Fibrinolysis at 30 and 60 min after MA (Ly30 and Ly60). The possible correlation between the distribution of the reference range and the gender, age, MELD score (higher or lower than 20) and indications for transplantation (liver pathology) were also investigated. In particular, a MELD cut-off value of 20 was chosen to verify the possible correlation between the thromboelastographic reference range and MELD score.
RESULTS Most of the TEG reference values from patients with end-stage liver disease were significantly different from those measured in the healthy population and were outside the suggested normal ranges in up to 79.3% of subjects. Wide differences were found among all TEG variables, including r (41.5% of the values), k (48.6%), α (43.7%), MA (79.3%), A30 (74.4%) and A60 (80.9%), indicating a prevailing trend to hypocoagulability. The differences between the mean TEG values obtained from healthy subjects and the cirrhotic population were statistically significant for r (P = 0.039), k (P < 0.001), MA (P < 0.001), A30 (P < 0.001), A60 (P < 0.001) and Ly60 (P = 0.038), indicating slower and less stable clot formation in the cirrhotic patients. In the cirrhotic population, 9.5% of patients had an r value shorter than normal, indicating a tendency for faster clot formation. Within the cirrhotic patient population, gender, age and the presence of hepatocellular carcinoma or alcoholic cirrhosis were not significantly associated with greater clot firmness or enhanced whole blood clot formation, whereas greater clot strength was associated with a MELD score < 20, hepatitis C virus and cholestatic-related cirrhosis (P < 0.001; P = 0.013; P < 0.001).
CONCLUSION The range and distribution of TEG values in cirrhotic patients differ from those of healthy subjects, suggesting that a specific thromboelastographic reference range is required for liver transplant candidates.
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19
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Bamber J. Point-of-care testing on the labour ward should be mandatory. Int J Obstet Anesth 2016; 27:69-74. [DOI: 10.1016/j.ijoa.2016.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/02/2016] [Indexed: 11/30/2022]
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20
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Gehrie EA, Baine I, Booth GS. Pathology Consultation on Viscoelastic Studies of Coagulopathic Obstetrical Patients. Am J Clin Pathol 2016; 146:149-55. [PMID: 27124951 DOI: 10.1093/ajcp/aqw044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES In obstetrics, the decision to transfuse blood components has historically been driven by traditional laboratory testing in combination with direct observation of bleeding. The adjunctive use of viscoelastic testing, including thromboelastometry and thromboelastography, has gained increasing acceptance in the clinical domain. METHODS We performed a review of the published medical literature by searching the PUBMED database for keywords "viscoelastic" and "obstetric," as well as "viscoelastic" and "postpartum hemorrhage." Additionally, case reports and expert opinion publications that referenced viscoelastic studies in obstetrical patients were evaluated. RESULTS There is very little high-quality evidence currently published in the medical literature to support the notion that viscoelastic testing obviates the need for traditional coagulation testing or improves mortality resulting from major obstetrical hemorrhage. CONCLUSIONS Additional research is needed to further focus the optimum role of viscoelastic tests in major obstetrical hemorrhage.
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Affiliation(s)
- Eric A Gehrie
- From the Department of Laboratory Medicine, Yale University, New Haven, CT;
| | - Ian Baine
- From the Department of Laboratory Medicine, Yale University, New Haven, CT
| | - Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, TN
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Wen J, Weinhart M, Lai B, Kizhakkedathu J, Brooks DE. Reversible hemostatic properties of sulfabetaine/quaternary ammonium modified hyperbranched polyglycerol. Biomaterials 2016; 86:42-55. [DOI: 10.1016/j.biomaterials.2016.01.067] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/31/2015] [Accepted: 01/29/2016] [Indexed: 11/15/2022]
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22
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Meesters MI, Koch A, Kuiper G, Zacharowski K, Boer C. Instability of the non-activated rotational thromboelastometry assay (NATEM) in citrate stored blood. Thromb Res 2015; 136:481-3. [DOI: 10.1016/j.thromres.2015.05.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 11/16/2022]
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Kasivisvanathan R, Koutra M, Rooms M, Black E, Desai L, Mallett SV, Rao-Baikady R. Thromboelastography (TEG®) compared with total platelet count in thrombocytopenia haematological malignancy patients with bleeding: a pilot observational study. Transfus Med 2015; 25:307-12. [DOI: 10.1111/tme.12221] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 06/06/2015] [Accepted: 06/08/2015] [Indexed: 11/26/2022]
Affiliation(s)
- R. Kasivisvanathan
- Department of Anaesthesia and Perioperative Care; The Royal Marsden NHS Foundation Trust; London UK
| | - M. Koutra
- Department of Anaesthesia and Perioperative Care; The Royal Marsden NHS Foundation Trust; London UK
| | - M. Rooms
- Department of Anaesthesia and Perioperative Care; The Royal Marsden NHS Foundation Trust; London UK
| | - E. Black
- Department of Research and Development; The Royal Marsden NHS Foundation Trust; London UK
| | - L. Desai
- Transfusion Laboratory; The Royal Marsden NHS Foundation Trust; London UK
| | - S. V. Mallett
- Department of Anaesthesia and Perioperative Care; The Royal Free NHS Foundation Trust; London UK
| | - R. Rao-Baikady
- Department of Anaesthesia and Perioperative Care; The Royal Marsden NHS Foundation Trust; London UK
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24
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Time impact on non-activated and kaolin-activated blood samples in thromboelastography. BMC Anesthesiol 2015; 15:50. [PMID: 25927487 PMCID: PMC4404121 DOI: 10.1186/s12871-015-0033-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 04/09/2015] [Indexed: 11/15/2022] Open
Abstract
Background The correct methodology of thrombelastography might be influenced by elapsing time. In our study we investigated kaolin activated citrated samples together with non-activated citrated samples in relation to the elapsed times of 0, 15 and 30 minutes to compare both methods and to find out if there is an impact of time on results of thrombelastography. Methods Blood samples obtained from 10 healthy volunteers were analyzed after 0, 15 and 30 minutes from sampling with kaolin activation and without activation. Then the results were analysed and compared between the non-activated and the kaolin-activated method. Results All blood samples became more hypercoagulable with the time elapsing, both in non-activated and kaolin-activated samples and differences between both groups were found statistically and clinically significant after only 0 minutes. Conclusions The non-activated citrated method seems to be reliable and suitable for thrombelastography in non-emergency cases (planned surgical procedures) when we have time to wait 15–30 minutes to get results. In urgent situations a rapid thrombelastography test should be preferred. Although the kaolin-activated method can also be used, results must be interpreted with caution.
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25
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Peng HT, Cameron BA, Rhind SG. Effects of Hyperbaric and Decompression Stress on Blood Coagulation and Fibrinolysis. Clin Appl Thromb Hemost 2015; 22:327-39. [DOI: 10.1177/1076029614568712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hyperbaric and decompression stress from diving impairs blood coagulation and fibrinolysis. We hypothesized that thromboelastography (TEG) and rotational thromboelastometry (ROTEM) were suitable to characterize the effects of stress on global hemostatic profiles. We thus conducted a comparative study of the hyperbaric effects on human coagulation using TEG and ROTEM. Maximum clot strength (maximum amplitude [MA]) and clot lysis (lysis index at time 30 minutes [LI30]) were reduced as indicated by TEG MA and EXTEM LI30, respectively. The relative changes in coagulation and fibrinolysis by the hyperbaric effects of diving were indicated by reduced TEG reaction time R at 5 hours, MA at 24 hours postdive, and reduced EXTEM coagulation time at 15 minutes postdive as well as decreased fibrinolysis (EXTEM LI30) at all postdiving time points investigated. Comparison of the parameter values and the diving-induced changes in each parameter between TEG and ROTEM showed both differences and correlations. The discrepancies between the 2 systems may be due to the different assay reagents used. Future studies will seek to further elucidate the changes in blood coagulation and fibrinolysis following varying levels of hyperbaric and decompression stress.
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Affiliation(s)
- Henry T. Peng
- Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada
| | - Bruce A. Cameron
- Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada
| | - Shawn G. Rhind
- Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada
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26
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Espinosa A, Seghatchian J. What is happening? The evolving role of the blood bank in the management of the bleeding patient: The impact of TEG as an early diagnostic predictor for bleeding. Transfus Apher Sci 2014; 51:105-10. [DOI: 10.1016/j.transci.2014.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Quarterman C, Shaw M, Johnson I, Agarwal S. Intra‐ and inter‐centre standardisation of thromboelastography (TEG
®
). Anaesthesia 2014; 69:883-90. [DOI: 10.1111/anae.12748] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2014] [Indexed: 02/05/2023]
Affiliation(s)
- C. Quarterman
- Department of Anaesthesia Liverpool Heart and Chest Hospital NHS Foundation Trust Liverpool UK
| | - M. Shaw
- Liverpool Heart and Chest Hospital NHS Foundation Trust Liverpool UK
| | - I. Johnson
- Liverpool Heart and Chest Hospital NHS Foundation Trust Liverpool UK
| | - S. Agarwal
- Department of Anaesthesia Liverpool Heart and Chest Hospital NHS Foundation Trust Liverpool UK
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Evaluation of the utility of thromboelastography in a tertiary trauma care centre. ISRN HEMATOLOGY 2014; 2014:849626. [PMID: 24695847 PMCID: PMC3947774 DOI: 10.1155/2014/849626] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 12/15/2013] [Indexed: 12/05/2022]
Abstract
Background. Thromboelastography (TEG) unlike conventional coagulation assays evaluates the dynamic interaction of clotting factors and platelets indicating an overall clot quality. Literature assessing the efficacy of TEG in identifying trauma associated bleeding is lacking. Aim. To compare TEG with conventional plasma based coagulation tests and assess whether TEG can serve as a screening test or replace the conventional routine test. Materials. Retrospective data was collected for 150 severe trauma patients. Patients with known evidence of severe comorbidities, which may influence the outcome, were excluded. Detailed evaluation of the patient's clinical and laboratory records was conducted. Diagnostic characteristics such as sensitivity, specificity, and accuracy were calculated. Results. Fifty-one patients were defined as coagulopathic by the conventional coagulation test, 30 by the laboratory established range for TEG indices and 105 by manufactures range. Specificity and sensitivity for the laboratory established range for TEG were 29.4% and 84.8%; for manufactures range sensitivity was 74.5%, specificity was 32.3%. Conclusion. We observed that conventional coagulation assays are the most sensitive tests for diagnosis of coagulopathy due to trauma. However in emergency trauma situations, where immediate corrective measures need to be taken, coagulation parameters and conventional coagulation tests may cause delay. TEG can give highly specific results depicting the underlying coagulopathy.
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29
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de Laforcade A, Goggs R, Wiinberg B. Systematic evaluation of evidence on veterinary viscoelastic testing Part 3: Assay activation and test protocol. J Vet Emerg Crit Care (San Antonio) 2014; 24:37-46. [DOI: 10.1111/vec.12147] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 11/15/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Armelle de Laforcade
- From the Department of Clinical Sciences; Cummings School of Veterinary Medicine; Tufts University; North Grafton MA
| | - Robert Goggs
- Department of Clinical Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY, 14853
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30
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Goggs R, Brainard B, de Laforcade AM, Flatland B, Hanel R, McMichael M, Wiinberg B. Partnership on Rotational ViscoElastic Test Standardization (PROVETS): Evidence-based guidelines on rotational viscoelastic assays in veterinary medicine. J Vet Emerg Crit Care (San Antonio) 2014; 24:1-22. [DOI: 10.1111/vec.12144] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 11/15/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Robert Goggs
- From the Department of Clinical Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY 14853
| | - Benjamin Brainard
- Department of Small Animal Medicine & Surgery, College of Veterinary Medicine; University of Georgia; Athens GA 30602
| | - Armelle M. de Laforcade
- Department of Clinical Sciences; Tufts Cummings School of Veterinary Medicine; North Grafton MA 01536
| | - Bente Flatland
- Department of Pathobiology, College of Veterinary Medicine; University of Tennessee; Knoxville TN 37996
| | - Rita Hanel
- Department of Clinical Sciences, College of Veterinary Medicine; NC State University; Raleigh NC 27607
| | - Maureen McMichael
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine; University of Illinois; Urbana IL 61801
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31
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Hellum M, Øvstebø R, Brusletto BS, Berg JP, Brandtzaeg P, Henriksson CE. Microparticle-associated tissue factor activity correlates with plasma levels of bacterial lipopolysaccharides in meningococcal septic shock. Thromb Res 2013; 133:507-14. [PMID: 24423888 DOI: 10.1016/j.thromres.2013.12.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/11/2013] [Accepted: 12/20/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The plasma level of bacterial lipopolysaccharides (LPS) is associated with activation of the coagulation system, inhibition of fibrinolysis and the nature of the clinical presentation and outcome in patients with meningococcal disease. Tissue factor (TF)-bearing microparticles (MPs) appear to contribute to the pathogenesis of disseminated intravascular coagulation (DIC). The aim of this study was to investigate the relationship between MP-associated TF activity and the level of bacterial LPS in plasma from patients with meningococcal septic shock and meningitis. MATERIALS AND METHODS MPs isolated from citrated plasmas were assessed for TF-dependent activity with both a plasma-based thrombin generation assay (CAT) and whole blood-based thromboelastometry (ROTEM). The LPS level was measured using a chromogenic Limulus amebocyte lysate assay. RESULTS MPs obtained from patients with meningococcal septic shock initiated significantly more efficient and TF-dependent thrombin generation in the CAT assay compared to MPs from patients with meningococcal meningitis. Differences in MP-associated TF activity between the septic shock patients and the meningitis patients were also evident when MPs were added to whole blood using ROTEM. The level of plasma LPS in patients with septic shock (range 2-2,100 EU/mL) was correlated with thrombogram parameters in the CAT assay; lagtime (r(s)=-0.84), time to peak (rs=-0.83), peak (r(s)=0.85) and ETP (r(s)=0.83). CONCLUSIONS MPs obtained from patients with meningococcal septic shock displayed more efficient TF-dependent thrombin generation and clot formation compared to MPs from meningitis patients. MP-associated TF activity was closely associated with plasma LPS levels in the septic shock group.
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Affiliation(s)
- Marit Hellum
- Institute of Clinical Medicine, University of Oslo, Norway; Blood Cell Research Group, Section for Research, Department of Medical Biochemistry, Oslo University Hospital, Norway.
| | - Reidun Øvstebø
- Blood Cell Research Group, Section for Research, Department of Medical Biochemistry, Oslo University Hospital, Norway
| | - Berit S Brusletto
- Blood Cell Research Group, Section for Research, Department of Medical Biochemistry, Oslo University Hospital, Norway
| | - Jens P Berg
- Institute of Clinical Medicine, University of Oslo, Norway; Blood Cell Research Group, Section for Research, Department of Medical Biochemistry, Oslo University Hospital, Norway
| | - Petter Brandtzaeg
- Institute of Clinical Medicine, University of Oslo, Norway; Blood Cell Research Group, Section for Research, Department of Medical Biochemistry, Oslo University Hospital, Norway; Department of Pediatrics, Oslo University Hospital, Norway
| | - Carola E Henriksson
- Blood Cell Research Group, Section for Research, Department of Medical Biochemistry, Oslo University Hospital, Norway; Section for Hemostasis and Thrombosis, Department of Medical Biochemistry, Oslo University Hospital, Norway
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32
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Peng HT, Rhind SG. Thromboelastographic Study of Psychophysiological Stress: A Review. Clin Appl Thromb Hemost 2013; 21:497-512. [PMID: 24254897 DOI: 10.1177/1076029613512415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Thromboelastography (TEG) is drawing more attention for clinical and laboratory studies of hemostasis. It has been applied to evaluate the effects of both psychological and physiological stress on whole blood coagulation from the onset of the coagulation cascade through clot formation, to the end with fibrinolysis. We conducted a comprehensive review on the applications of TEG for assessment of different stressors, ranging from physical exercise to emotional situations. The methodology is unique in terms of instrumentation, the methods to activate blood coagulation, the type of blood (citrated vs fresh blood), and study settings (in vitro vs in vivo vs clinical trials). Thromboelastography has most often been used to study the effects of physiological stress. The author's own work and future directions are discussed as well. The review would facilitate future development of TEG for evaluating hemostasis and potential pathological pathways in response to various forms of stress.
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Affiliation(s)
- Henry T Peng
- Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada
| | - Shawn G Rhind
- Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada
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33
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Gilman EA, Koch CD, Santrach PJ, Schears GJ, Karon BS. Fresh and citrated whole-blood specimens can produce different thromboelastography results in patients on extracorporeal membrane oxygenation. Am J Clin Pathol 2013; 140:165-9. [PMID: 23897250 DOI: 10.1309/ajcpyiq9jnnsen4q] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To compare thromboelastography (TEG) tracings obtained from fresh and citrated whole-blood samples in patients on extracorporeal membrane oxygenation (ECMO) or after cardiopulmonary bypass and in healthy volunteers. METHODS Samples of fresh and citrated whole blood were analyzed for 25 patients and 4 healthy volunteers. Thromboelastography analysis was performed in both plain and heparinase cups. RESULTS In 5 of 6 patients on ECMO, use of citrated samples resulted in apparent partial or complete heparin reversal. In TEG tracings from patients following cardiopulmonary bypass, there was a slight hypercoagulable appearance in the citrated sample. No differences were noted between fresh and citrated samples from healthy volunteers whose blood was spiked with heparin. CONCLUSIONS In some patients on ECMO, use of samples collected in sodium citrate tubes for TEG analysis results in significant artifacts, which could lead to heparin overdosing in these patients.
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Affiliation(s)
- Elizabeth A. Gilman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN. Dr Gilman is currently with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ
| | - Christopher D. Koch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN. Dr Gilman is currently with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ
| | - Paula J. Santrach
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN. Dr Gilman is currently with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ
| | - Gregory J. Schears
- Department of Anesthesiology, Mayo Clinic, Rochester, MN. Dr Gilman is currently with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ
| | - Brad S. Karon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN. Dr Gilman is currently with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ
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Abstract
Increased focus on traumatic coagulopathy over the last decade has led to more aggressive use of hemostatic agents in resuscitation of the massively bleeding patient. Novel formulations of plasma factors and other therapeutics have opened for early intervention to prevent coagulopathy and may even be utilized in the prehospital setting. Careful selection of patients to receive hemostatic agents early during the resuscitation is of great importance due to the potential detrimental effects of this treatment. Several studies have identified coagulation parameters as reliable predictors of massive transfusion, even very early after trauma. Prothrombin time international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), fibrinogen concentration, and viscoelastic tests such as thrombelastography (TEG) and rotational thrombelastometry (RoTEM) have proved to be of value in predicting massive transfusion when performed in-hospital. PT/INR appears to be slightly more accurate than the other parameters, with a reported sensitivity of 84.8% and an area under the receiver operating curve of 0.87. Comparison studies on PT/INR, aPTT, and viscoelastic assays do suggest that caution should be taken when point-of-care (POC) methods, as opposed to conventional laboratory analyses, are used. Novel techniques for POC measurement of fibrinogen levels are currently being developed, and preclinical data suggest acceptable agreement with conventional methods. A number of factors should be considered regarding the feasibility of POC tests in the prehospital environment. In addition to environmental factors such as temperature, altitude, and humidity, electromagnetic interference issues and operators' skills must be taken into account. Coagulation parameters appear to be a useful tool in identifying patients with increased risk of massive bleeding at an early stage. Further studies are needed to determine if prehospital intervention based on POC analyses improves outcome.
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Affiliation(s)
- Jostein S Hagemo
- Department of Research, Norwegian Air Ambulance Foundation, Drobak, Norway.
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Martin J, Schuster T, Moessmer G, Kochs E, Wagner K. Alterations in rotation thromboelastometry (ROTEM ® ) parameters: point-of-care testing vs analysis after pneumatic tube system transport. Br J Anaesth 2012; 109:540-5. [DOI: 10.1093/bja/aes213] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sankarankutty A, Nascimento B, Teodoro da Luz L, Rizoli S. TEG® and ROTEM® in trauma: similar test but different results? World J Emerg Surg 2012; 7 Suppl 1:S3. [PMID: 23531394 PMCID: PMC3424963 DOI: 10.1186/1749-7922-7-s1-s3] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction Transfusion in trauma is often empiric or based on traditional lab tests. Viscoelastic tests such as thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®) have been proposed as superior to traditional lab tests. Due to the similarities between the two tests, general opinion seems to consider them equivalent with interchangeable interpretations. However, it is not clear whether the results can be similarly interpreted. This review evaluates the comparability between TEG and ROTEM and performs a descriptive review of the parameters utilized in each test in adult trauma patients. Methods PUBMED database was reviewed using the keywords “thromboelastography” and “compare”, between 2000 and 2011. Original studies directly comparing TEG® with ROTEM® in any area were retrieved. To verify the individual test parameter used in studies involving trauma patients, we further performed a review using the keywords “thromboelastography” and “trauma” in the PUBMED database. Results Only 4 studies directly compared TEG® with ROTEM®. One in liver transplantation found that transfusion practice could differ depending on the device in use. Another in cardiac surgery concluded that all measurements are not completely interchangeable. The third article using commercially available plasma detected clinically significant differences in the results from the two devices. The fourth one was a head-to-head comparison of the technical aspects. The 24 articles reporting the use of viscoelastic tests in trauma patients, presented considerable heterogeneity. Conclusion Both tests are potentially useful as means to rapidly diagnose coagulopathy, guide transfusion and determine outcome in trauma patients. Differences in the activators utilized in each device limit the direct comparability. Standardization and robust clinical trials comparing the two technologies are needed before these tests can be widely recommended for clinical use in trauma.
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Affiliation(s)
- Ajith Sankarankutty
- Departments of Surgery and Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
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Thromboelastography: New concepts in haemostasis physiology and correlation with trauma associated coagulopathy. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1016/j.rcae.2012.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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38
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Galvez K, Cortes C. Tromboelastografía: nuevos conceptos en la fisiología de la hemostasia y su correlación con la coagulopatía asociada al trauma. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.rca.2012.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Thromboelastography (TEG), used in liver transplant and cardiac surgery for nearly 50 years, has recently been applied to the trauma setting. Rodents are used widely for shock research, but are known to have differences in their coagulation system compared with humans. Consequently, the appropriate technique for performing TEG requires modification of the standard clinical protocol. Thromboelastography was performed with blood collected from the femoral artery of rodents, and technical modifications were tested to optimize results. Analysis of citrated whole blood using TEG revealed a more rapid onset of coagulation in rats compared with humans. The reference ranges of TEG parameters for Sprague-Dawley rats are detailed. Citrated native whole blood is the optimal TEG method in the assessment of coagulation in rodents. Investigators using TEG for research purposes should establish their own reference ranges to determine normal values for their target population.
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40
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Blois SL, Banerjee A, Darren Wood R. Evaluation of thrombelastographic platelet-mapping in healthy cats. Vet Clin Pathol 2012; 41:223-7. [DOI: 10.1111/j.1939-165x.2012.00419.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - R. Darren Wood
- Departments of Pathobiology; Ontario Veterinary College; University of Guelph; Guelph; Ontario; Canada
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41
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Thromboelastography: New concepts in haemostasis physiology and correlation with trauma associated coagulopathy☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1097/01819236-201240030-00011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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42
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Peng HT, Blostein MD, Shek PN. Characterization of In Vitro Hemostatic Peptide Effects by Thromboelastography. Clin Appl Thromb Hemost 2011; 18:27-34. [DOI: 10.1177/1076029611412371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
In this study, we validated a thromboelastography (TEG) method to evaluate the hemostatic effects of 3 peptides. The first peptide is an ideal amphipathic peptide composed of 22 leucine and lysine in a ratio of 2:1. At a very low concentration, the peptide had a procoagulant effect shown by decreases in reaction time (R) and coagulation time (K) but was impaired by a decrease in maximum amplitude (MA). At higher concentrations, the peptide had an anticoagulant effect. The α angle was minimally affected by the peptide. The second peptide is melittin derived from bee venom. Melittin showed procoagulant effects reflected by a decrease in clotting time but led to lower MA. The third peptide derived from fibrinogen γ chain promoted hemostasis only at an optimal concentration and became anticoagulant at a higher concentration. The hemostatic mechanisms of each peptide were discussed. Our study would facilitate further development of peptides for either hemorrhage control or thrombosis treatment.
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Affiliation(s)
- Henry T. Peng
- Defence Research and Development Canada, Toronto, Ontario, Canada
| | - Mark D. Blostein
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Pang N. Shek
- Defence Research and Development Canada, Toronto, Ontario, Canada
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Chitlur M, Sorensen B, Rivard GE, Young G, Ingerslev J, Othman M, Nugent D, Kenet G, Escobar M, Lusher J. Standardization of thromboelastography: a report from the TEG-ROTEM working group. Haemophilia 2011; 17:532-7. [PMID: 21323795 DOI: 10.1111/j.1365-2516.2010.02451.x] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Laboratory evaluation of bleeding disorders has been performed with the standard clotting assays such as the PT and PTT for several decades. Our improved understanding of the process of blood coagulation has now revealed the important role played by the cellular elements such as platelets, monocytes and red blood cells. The need for a test that can assess clotting in a more 'global' manner, beyond the initiation of clot formation, has led to greater interest in assays such as thrombin generation and thromboelastography. Even though there are several publications using thromboelastography it remains a research tool as the methodology is not standardized. In an attempt to show reproducibility and consistency using thromboelastography, a group of investigators from different countries joined hands to form the TEG-ROTEM Working Group. Two studies were performed using PRP and FVIII deficient plasma and an intrinsic pathway activator. This article summarizes the results of the first international effort at standardization of thromboelastography. Both of the instruments using this technology (TEG(®) and ROTEM(®)) were used. Nine laboratories from countries around the globe participated in this effort. The results showed a significant inter-laboratory variance with CV's greater than 10%. Although these results were not satisfactory, this has been the first effort to standardize this methodology and significant work remains to be done to improve reliability and reproducibility. These studies were performed on PRP and the results may be more reliable when preformed on whole blood samples. We believe that it is important to continue this work so that we may investigate the usefulness and potential applications of thromboelastography in the evaluation of bleeding and thrombosis.
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Affiliation(s)
- M Chitlur
- Division of Hematology/Oncology, Carman and Ann Adams Department of Pediatrics, Wayne State University/Children's Hospital of Michigan, Detroit, MI 48201, USA.
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Fenty RK, deLaforcade AM, Shaw SE, O'Toole TE. Identification of hypercoagulability in dogs with primary immune-mediated hemolytic anemia by means of thromboelastography. J Am Vet Med Assoc 2011; 238:463-7. [DOI: 10.2460/javma.238.4.463] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Thrombocytopenia affects plasmatic coagulation as measured by thrombelastography. Blood Coagul Fibrinolysis 2011; 21:389-97. [PMID: 20410815 DOI: 10.1097/mbc.0b013e328335d0e4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Thrombelastography (TEG) is used as a point-of-care test of hemostasis. Different components of the test tracing are considered to reflect various parts of the hemostatic system and to distinguish low platelet count, platelet dysfunction or both from lack of plasmatic coagulation factors. To analyze the influence of one single element of the coagulation system, namely the platelet count, we used TEG serially in patients with well documented transient thrombocytopenia. A total of 189 TEG analyses were performed from 16 patients with a hematological malignancy in remission, receiving consolidation courses of chemotherapy. TEG outcomes using unmanipulated and citrated blood samples at a median of 11 times (range 1-17) in the same patients during the decrease of platelet count in response to chemotherapy were compared with outcomes in 120 healthy adults from various age categories. We found a correlation (r = 0.7, P < 0.001) between TEG clot strength (maximum amplitude) and platelet count. Moreover, platelet count was correlated respectively with the initial rate of clot formation (reaction time and clotting time), the rate of clot growth (alpha angle), and also with maximum thrombus generation, time to maximum thrombus generation and total thrombus generation. We conclude that platelet count not only affects the strength of clot formation, as was expected, but also all other phases of plasmatic coagulation. Citration of the blood sample, aiming at easy storage of the material, masked some of the important biological parameters of coagulation.
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47
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Roeloffzen WWH, Kluin-Nelemans HC, Veeger NJGM, Bosman L, De Wolf JTM. Transfused stored platelets have the same haemostatic function as circulating native platelets. Vox Sang 2010; 99:123-30. [DOI: 10.1111/j.1423-0410.2010.01337.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chen Y, Qin S, Ding Y, Wei L, Zhang J, Li H, Bu H, Lu Y, Cheng J. Reference values of clinical chemistry and hematology parameters in rhesus monkeys (Macaca mulatta). Xenotransplantation 2010; 16:496-501. [PMID: 20042049 DOI: 10.1111/j.1399-3089.2009.00554.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Rhesus monkey models are valuable to the studies of human biology. Reference values for clinical chemistry and hematology parameters of rhesus monkeys are required for proper data interpretation. METHODS Whole blood was collected from 36 healthy Chinese rhesus monkeys (Macaca mulatta) of either sex, 3 to 5 yr old. Routine chemistry and hematology parameters, and some special coagulation parameters including thromboelastograph and activities of coagulation factors were tested. RESULTS AND CONCLUSION We presented here the baseline values of clinical chemistry and hematology parameters in normal Chinese rhesus monkeys. These data may provide valuable information for veterinarians and investigators using rhesus monkeys in experimental studies.
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Affiliation(s)
- Younan Chen
- West China Hospital, Sichuan University, Chengdu, China
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Roeloffzen WWH, Kluin-Nelemans HC, Bosman L, de Wolf JTM. Effects of red blood cells on hemostasis. Transfusion 2010; 50:1536-44. [PMID: 20158685 DOI: 10.1111/j.1537-2995.2010.02586.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Currently there is no sensitive laboratory test to establish the influence of red blood cells (RBCs) on hemostasis. As thromboelastography (TEG) measures hemostasis in whole blood, taking into account the interactions of all cellular elements, we used this instrument to investigate the role that RBCs play in hemostasis. STUDY DESIGN AND METHODS In 29 patients with chemotherapy-induced anemia we studied the effect of progressive anemia on the coagulation profile. In 24 patients with chronic anemia we studied the effect of transfusion of RBCs on coagulation. Finally, in 18 patients we evaluated whether storage time of RBCs has additional effects on hemostasis. RESULTS We observed a significant negative correlation between hemoglobin and TEG variables related to both clot strength and elasticity (p < 0.05). Moreover, anemia was associated with a delay in the initiation of the coagulation cascade. Correction of anemia by RBC transfusion resulted in significant shortening of this initiation phase with now the opposite effect on clot strength and elasticity. The negative effects on clot quality were significantly worse when fresh RBCs were transfused compared to longer-stored RBCs. Furthermore, in contrast to the longer-stored RBCs, fresh RBCs did not enhance initial fibrin formation. CONCLUSIONS In this study we found that anemia was associated with a delay in the initiation of the coagulation cascade with a finally formed clot with superior strength and viscoelastic properties. Transfusion of RBCs was associated with impaired clot quality, with even worse effects on the initial fibrin build-up and clot quality by fresh RBCs.
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Affiliation(s)
- Wilfried W H Roeloffzen
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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50
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Peng HT, Huang Huang, Shek PN, Charbonneau S, Blostein MD. PEGylation of Melittin: Structural Characterization and Hemostatic Effects. J BIOACT COMPAT POL 2010. [DOI: 10.1177/0883911509354230] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To promote and understand the structure—property relationship for hemostasis, we modified melittin (MLT) using a four-arm poly(ethylene glycol) (PEG) with N-hydroxysuccinimide ester. The PEGylation was characterized by FTIR, MALDI-MS, NMR, a bicinchoninic acid assay, circular dichroism, hemolysis assay, and thromboelastography. Changes in the reaction conditions affected the extent of the modification, the numbers of MLT conjugated to PEG arms, and possible PEGylation sites. The reaction at pH 9.2 with a high MLT/PEG ratio, resulted in the highest modification. Reactions in dimethylsulfoxide (DMSO) resulted in more multi-arm coupled MLT, reaching a maximum of four MLT per PEG. The helicity of the modified peptide, relative to the native peptide, was essentially maintained in DMSO, but substantially lost at pH 9.2. PEGylation reduced the hemolytic effects of MLT and subsequently changed its coagulation profiles. The overall hemostatic effects of MLT modified in DMSO indicate that this may be a convenient approach to the PEGylation of biomolecules for biomedical applications.
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Affiliation(s)
- Henry T. Peng
- Defence Research and Development Canada - Toronto, 1133 Sheppard Avenue West, P.O. Box 2000, Toronto, Ontario, Canada,
| | - Huang Huang
- Defence Research and Development Canada - Toronto, 1133 Sheppard Avenue West, P.O. Box 2000, Toronto, Ontario, Canada
| | - Pang N. Shek
- Defence Research and Development Canada - Toronto, 1133 Sheppard Avenue West, P.O. Box 2000, Toronto, Ontario, Canada
| | - Sophie Charbonneau
- Lady Davis Institute of Medical Research, Jewish General Hospital McGill University, Montreal, Quebec, Canada
| | - Mark D. Blostein
- Lady Davis Institute of Medical Research, Jewish General Hospital McGill University, Montreal, Quebec, Canada
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