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Thrombelastography

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https://www.readbyqxmd.com/read/29709368/empiric-transfusion-strategies-during-life-threatening-hemorrhage
#1
Geoffrey R Nunns, Ernest E Moore, Gregory R Stettler, Hunter B Moore, Arsen Ghasabyan, Mitchell Cohen, Benjamin R Huebner, Christopher C Silliman, Anirban Banerjee, Angela Sauaia
BACKGROUND: Resuscitation guided by thrombelastography improves survival after injury. If bleeding is rapid, however, or if no thrombelastography data are available, the optimal strategy remains controversial. Our current practice gives fresh frozen plasma and red blood cells (1:2) empirically in patients with life-threatening hemorrhage, with subsequent administration based on rapid thrombelastography. We identified patients at risk of massive transfusion at 1 hour, examined their initial rapid thrombelastography, and used this value to provide empiric recommendations about transfusions...
April 27, 2018: Surgery
https://www.readbyqxmd.com/read/29664836/teg-lysis-shutdown-represents-coagulopathy-in-bleeding-trauma-patients-analysis-of-the-proppr-cohort
#2
Jessica C Cardenas, Charles E Wade, Bryan A Cotton, Mitchell J George, John B Holcomb, Martin A Schreiber, Nathan J White
BACKGROUND: Thrombelastography (TEG) fibrinolysis shutdown after trauma is associated with increased mortality due to hypercoagulability-associated organ failure. However, a lack of mechanistic data has precluded the development of novel interventions to treat shutdown. OBJECTIVES: To define the pathophysiology of TEG shutdown in severely injured, bleeding patients through secondary analysis of the PROPPR trial. METHODS: Fibrinolysis was characterized in PROPPR subjects using admission TEG lysis at 30 minutes (LY30) or plasmin-antiplasmin (PAP) levels...
April 16, 2018: Shock
https://www.readbyqxmd.com/read/29621120/absences-of-endothelial-microvesicle-changes-in-the-presence-of-the-endotheliopathy-of-trauma
#3
Charles E Wade, Nena Matijevic, Yao-Wei W Wang, Erika Gonzalez Rodriguez, Ernesto Lopez, Sisse R Ostrowski, Jessica C Cardenas, Lisa A Baer, Tzu-An Chen, Jeffrey S Tomasek, Hanne H Henriksen, Jakob Stensballe, Bryan A Cotton, John B Holcomb, Pär I Johansson
INTRODUCTION: Severe trauma is accompanied by endothelial glycocalyx disruption, which drives coagulopathy, increasing transfusion requirements and death. This syndrome has been termed traumatic endotheliopathy (EOT). Some have suggested EOT results from endothelial cellular damage and apoptosis. Endothelial microvesicles (EMVs) represent cellular damage. We hypothesized that EOT is associated with endothelial damage and apoptosis resulting in an increase in circulating EMVs. METHODS: Prospective, observational study enrolling severely injured patients...
April 4, 2018: Shock
https://www.readbyqxmd.com/read/29605725/utility-of-viscoelastic-assays-beyond-coagulation-can-preoperative-thrombelastography-indices-predict-tumor-histology-nodal-disease-and-resectability-in-patients-undergoing-pancreatectomy
#4
Hunter B Moore, Alessandro Paniccia, Peter J Lawson, Robert Torphy, Trevor L Nydam, Ernest E Moore, Martin D McCarter, Richard D Schulick, Barish H Edil
BACKGROUND: Since the 1860's hypercoagulability and malignancy have been linked. However, the impact of different neoplasms on multiple components of the coagulation system remains poorly understood. Thrombelastography (TEG) enables measurement of coagulation incorporating clotting through fibrinolysis. We hypothesize that specific TEG indices are associated with hypercoagulability can be appreciated in patients with adenocarcinoma undergoing pancreatic resection. STUDY DESIGN: Blood samples were obtained in patients undergoing pancreatic resection before surgical incision and assayed with TEG...
March 29, 2018: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29554044/systemic-hyperfibrinolysis-after-trauma-a-pilot-study-of-targeted-proteomic-analysis-of-superposed-mechanisms-in-patient-plasma
#5
Anirban Banerjee, Christopher C Silliman, Ernest E Moore, Monika Dzieciatskowa, Marguerite Kelher, Angela Sauaia, Kenneth Jones, Michael P Chapman, Eduardo Gonzalez, Hunter B Moore, Angelo D'Alessandro, Erik Peltz, Benjamin E Huebner, Peter Einerson, James Chandler, Arsen Ghasabayan, Kirk Hansen
BACKGROUND: Viscoelastic measurements of hemostasis indicate that 20% of seriously injured patients exhibit systemic hyperfibrinolysis, with increased early mortality. These patients have normal clot formation with rapid clot lysis. Targeted proteomics was applied to quantify plasma proteins from hyperfibrinolytic (HF) patients to elucidate potential pathophysiology. METHODS: Blood samples were collected in the field or at Emergency Department arrival and thrombelastography (TEG) was used to characterize in vitro clot formation under native and tissue plasminogen activator (tPA)-stimulated conditions...
March 16, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29532455/a-study-of-coagulation-changes-at-early-stage-after-total-knee-arthroplasty
#6
Jian Huang, Peng Zhang, Dawei Wang
Coagulation changes after total knee arthroplasty (TKA) can provide evidence for optimization of timing of perioperative anticoagulation medicine. To evaluate the changes, 50 patients with knee osteoarthritis or rheumatoid arthritis were recruited for the study and underwent thrombelastography tests pre-, 6 hours, 12 hours, and 24 hours after TKA surgery and Doppler ultrasound examination 20 to 24 hours after surgery. The results have shown prolonged clotting time ( R value) at 6 and 12 hours, while shortened at 24 hours...
January 30, 2018: Journal of Knee Surgery
https://www.readbyqxmd.com/read/29519292/-evaluation-of-platelet-function-in-critically-ill-patients-and-its-clinical-significance
#7
Hepeng Fu, Yuxiang Zhang
Platelets play a pivotal role in the thromboembolic, inflammatory, and immunomodulatory process. The alteration of platelet quality often affects the treatment and prognosis of critically ill patients, and has a significant correlation with mortality. With the further research on the function of the platelet, it is found that the abnormal platelet quality can present during the early stage of the illness of the critically ill patients. In order to evaluate the alterations of the platelet quality more accurately, the further studies of platelet parameters, including platelet counts (PLT), platelet hematocrit (PCT), platelet large cell ratio (PLCR), mean platelet volume (MPV), platelet distribution width (PDW), immature platelet fraction (IPF) and so on, are still be the focus of current researches in the field of critical illness...
March 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29517967/the-use-of-viscoelastic-haemostatic-assays-in-non-cardiac-surgical-settings-a-systematic-review-and-meta-analysis
#8
REVIEW
Massimo Franchini, Carlo Mengoli, Mario Cruciani, Marco Marietta, Giuseppe Marano, Stefania Vaglio, Simonetta Pupella, Eva Veropalumbo, Francesca Masiello, Giancarlo M Liumbruno
BACKGROUND: Thrombelastography (TEG) and rotational thromboelastometry (ROTEM) are viscoelastic haemostatic assays (VHA) which exploit the elastic properties of clotting blood. The aim of this systematic review and meta-analysis was to evaluate the usefulness of these tests in bleeding patients outside the cardiac surgical setting. MATERIALS AND METHODS: We searched the Cochrane Library, MEDLINE, EMBASE and SCOPUS. We also searched clinical trial registries for ongoing and unpublished studies, and checked reference lists to identify additional studies...
May 2018: Blood Transfusion, Trasfusione del Sangue
https://www.readbyqxmd.com/read/29507861/fibrin-clot-strength-in-patients-with-diabetes-mellitus-measured-by-thrombelastography
#9
Benjamin T Maatman, Glen Schmeisser, Rolf P Kreutz
Background: Patients with diabetes mellitus (DM) exhibit increased risk of recurrent myocardial infarction. Maximal clot strength measured by thrombelastography (TEG) is a risk factor for recurrent ischemic events. We hypothesized that diabetic subjects exhibit increased fibrin clot strength in platelet-poor plasma and that glycemic control correlates with maximal fibrin clot strength. Methods: We collected plasma samples from subjects with known or suspected coronary artery disease undergoing cardiac catheterization ( n = 354)...
2018: Journal of Diabetes Research
https://www.readbyqxmd.com/read/29502661/discussion-of-coagulation-profile-following-liver-resection-does-liver-cirrhosis-affect-thrombelastography
#10
(no author information available yet)
No abstract text is available yet for this article.
March 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/29479891/the-clinical-implications-of-thrombelastography-in-the-diagnosis-of-acute-cerebral-infarction
#11
Ying Liang, Jun Wu, Jianquan Liu, Hong Liu, Juan Chen
BACKGROUND: Thrombelastography (TEG) is an analyzer reflecting the dynamic changes of blood coagulation. It has been used as a diagnosis index in many diseases. The aim of this study was to evaluate the relationship between TEG and acute cerebral infarction. METHODS: Eighty patients with acute cerebral infarction and 80 healthy controls were enrolled. Each patient's TEG results and routine coagulation indices were recorded. All analyses were conducted with SPSS16...
January 1, 2018: Clinical Laboratory
https://www.readbyqxmd.com/read/29461279/individualized-antithrombotic-therapy-in-heartware-hvad-recipients
#12
Erik N Sorensen, Hannah J Voorhees, Lynn M Dees, Si M Pham, Zachary N Kon, Bartley P Griffith, Erika D Feller
There are no evidence-based guidelines for antithrombotic therapy in left ventricular assist device patients. We evaluated the efficacy of a multi-agent, test-guided protocol, which remained consistent throughout our use of the Heartware HVAD. Thrombelastography and PFA-100 guide antiplatelet titration. Goals are normal kaolin thrombelastography maximum amplitude and prolonged PFA-100. We analyzed incidence and rates of nonprocedural bleeding, stroke, and pump thrombosis for all 81 primary Heartware left ventricular assist devices implanted since 2011...
February 15, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29449126/thrombelastography-suggests-hypercoagulability-in-patients-with-renal-dysfunction-and-intracerebral-hemorrhage
#13
Kevin Meier, Daniel M Saenz, Glenda L Torres, Chunyan Cai, Mohammed H Rahbar, Mark McDonald, Stuart Fraser, Elena Espino, H Alex Choi, Nancy J Edwards, Kiwon Lee, James C Grotta, Tiffany R Chang
BACKGROUND: The objective of this study was to quantify coagulopathy using thrombelastography (TEG) in patients with renal dysfunction and intracerebral hemorrhage (ICH). METHODS: We reviewed patients admitted with spontaneous ICH between November 2009 and May 2015. TEG was performed at the time of admission. Creatinine clearance (CCr) was calculated using the Cockroft-Gault equation. Patients were divided into 2 groups based on normal (CCr ≥ 90) or reduced renal function (CCr < 90)...
May 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29341793/platelet-transfusion-does-not-improve-outcomes-in-patients-with-brain-injury-on-antiplatelet-therapy
#14
Jeremy L Holzmacher, Cassandra Reynolds, Mayur Patel, Patrick Maluso, Seth Holland, Nathaniel Gamsky, Henry Moore, Elizabeth Acquista, Matthew Carrick, Richard Amdur, Heather Hancock, Michael Metzler, Julie Dunn, Babak Sarani
INTRODUCTION: Platelet dysfunction following traumatic brain injury (TBI) is associated with worse outcomes. The efficacy of platelet transfusion to reverse antiplatelet medication (APM) remains unknown. Thrombelastography platelet mapping (TEG-PM) assesses platelet function. We hypothesize that platelet transfusion can reverse the effects of APM but does not improve outcomes following TBI. METHODS: An observational study at six US trauma centres was performed. Adult patients on APM with CT evident TBI after blunt injury were enrolled...
2018: Brain Injury: [BI]
https://www.readbyqxmd.com/read/29304563/the-anticoagulant-effect-of-therapeutic-levels-of-dabigatran-in-atrial-fibrillation-evaluated-by-thrombelastography-teg-%C3%A2-hemoclot-thrombin-inhibitor-hti-assay-and-ecarin-clotting-time-ect
#15
Sacha Solbeck, Annette Schophuus Jensen, Christian Maschmann, Jakob Stensballe, Sisse Rye Ostrowski, Pär I Johansson
Monitoring the effect of dabigatran (Pradaxa® ) is challenging. The aim of this study was to evaluate if thrombelastography reaction time (TEG® R) could detect the anticoagulant effect of dabigatran showing a correlation between TEG® R, Hemoclot Thrombin Inhibitor (HTI) assay and Ecarin Clotting Time (ECT) in patients with non-valvular atrial fibrillation (NVAF). Blood samples from 35 AF patients receiving either 110 mg (n 19) or 150 mg (n 16) dabigatran twice daily were analyzed with TEG® , HTI and ECT 2-3 h after dabigatran intake...
February 2018: Scandinavian Journal of Clinical and Laboratory Investigation
https://www.readbyqxmd.com/read/29302119/teg-directed-transfusion-in-complex-cardiac-surgery-impact-on-blood-product-usage
#16
Kevin Fleming, Roberta E Redfern, Rebekah L March, Nathan Bobulski, Michael Kuehne, John T Chen, Michael Moront
Complex cardiac procedures often require blood transfusion because of surgical bleeding or coagulopathy. Thrombelastography (TEG) was introduced in our institution to direct transfusion management in cardiothoracic surgery. The goal of this study was to quantify the effect of TEG on transfusion rates peri- and postoperatively. All patients who underwent complex cardiac surgery, defined as open multiple valve repair/replacement, coronary artery bypass grafting with open valve repair/replacement, or aortic root/arch repair before and after implementation of TEG were identified and retrospectively analyzed...
December 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29289392/abnormalities-of-laboratory-coagulation-tests-versus-clinically-evident-coagulopathic-bleeding-results-from-the-prehospital-resuscitation-on-helicopters-study-prohs
#17
Ronald Chang, Erin E Fox, Thomas J Greene, Michael D Swartz, Stacia M DeSantis, Deborah M Stein, Eileen M Bulger, Sherry M Melton, Michael D Goodman, Martin A Schreiber, Martin D Zielinski, Terence O'Keeffe, Kenji Inaba, Jeffrey S Tomasek, Jeanette M Podbielski, Savitri Appana, Misung Yi, Pär I Johansson, Hanne H Henriksen, Jakob Stensballe, Jacob Steinmetz, Charles E Wade, John B Holcomb
BACKGROUND: Laboratory-based evidence of coagulopathy (LC) is observed in 25-35% of trauma patients, but clinically-evident coagulopathy (CC) is not well described. METHODS: Prospective observational study of adult trauma patients transported by helicopter from the scene to nine Level 1 trauma centers in 2015. Patients meeting predefined highest-risk criteria were divided into CC+ (predefined as surgeon-confirmed bleeding from uninjured sites or injured sites not controllable by sutures) or CC-...
April 2018: Surgery
https://www.readbyqxmd.com/read/29280928/thrombin-provokes-degranulation-of-platelet-%C3%AE-granules-leading-to-the-release-of-active-plasminogen-activator-inhibitor-1-pai-1
#18
Benjamin R Huebner, Ernest E Moore, Hunter B Moore, Gregory R Stettler, Geoffrey R Nunns, Peter Lawson, Angela Sauaia, Marguerite Kelher, Anirban Banerjee, Christopher C Silliman
BACKGROUND: The balance of fibrinolytic mediators is crucial to the survival of the critically ill patient, with tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) playing significant roles. While elevated levels of PAI-1 are associated with increased morbidity and mortality, the source of this PAI-1 remains elusive. Platelets contain 90% of circulating plasma PAI-1, however, their ability to release active PAI-1 is controversial. We hypothesize platelets contain active PAI-1 in α-granules capable of immediate degranulation when exposed to high concentrations of thrombin...
December 26, 2017: Shock
https://www.readbyqxmd.com/read/29276028/evaluation-for-effects-of-severe-acidosis-on-hemostasis-in-trauma-patients-using-thrombelastography-analyzer
#19
Xin Lv, Yong Mao, Zonghe Qin
OBJECTIVE: To investigate effects of metabolic acidosis on hemostasis function in trauma patients using thromboelastography analyzer. METHODS: 65 critically injured patients and 19 healthy volunteers were enrolled in the study. Three samples of whole blood were collected from each patient or healthy volunteer. These three samples were acidified with 50mmol/l phosphate-buffered saline (PBS) (pH5.8) or a neutral buffer (50mmol/l phosphate, pH7.4) and acidified blood sample with target pH of 6...
December 14, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29243334/effects-of-a-targeted-blood-management-programme-on-allogeneic-blood-transfusion-in-abdominal-aortic-aneurysm-surgery
#20
M D Stoneham, S Von Kier, L Harvey, M Murphy
OBJECTIVES: To investigate the impact of a dedicated cell salvage practitioner team on blood loss and allogeneic transfusion in abdominal aortic aneurysm (AAA) surgery. BACKGROUND: Cell salvage reduces allogeneic transfusion in AAA surgery, but is commonly performed by the anaesthetic nurse. At our hospital, a dedicated patient blood management practitioner is present for all elective open AAA repairs. METHODS/MATERIALS: Data were collected on 171 AAA patients operated on at the John Radcliffe Hospital, Oxford over a 3-year period, looking at the Patient Blood Management processes, including: blood loss, cell salvage, near-patient testing (thrombelastography) and transfusion rates of allogeneic blood products...
December 15, 2017: Transfusion Medicine
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