Thromboelastography

Thromboelastography (TEG)

Thromboelastography, is a method of testing the efficiency of blood coagulation. It is a test mainly utilized in surgery and anesthesiology, although few centers are capable of performing it. More common tests of blood coagulation include prothrombin time (PT,INR) and partial thromboplastin time (aPTT) which measure coagulation factor function, but TEG also can assess platelet function, clot strength, and fibrinolysis which these other tests cannot.

TEG may be a clinically sensitive test for identifying the underlying coagulopathyfollowing TBI. However, confirmation with conventional coagulation tests (CCTs) is recommended 1).


Platelet function testing with TEG altered a dual antiplatelet therapy (DAT) induction strategy in a significant number of cases.

Future studies should compare methods of platelet function testing and, possibly, no platelet function testing in neurovascular patients undergoing flow diversion and/or stent-assisted treatment of intracranial aneurysms 2).


Fulkerson et al. describe a 12-year-old female who experienced a number of complications after a craniopharyngioma surgery. The patient suffered multiple new intraventricular hemorrhages with removal of external ventricular drains. Standard coagulopathy tests did not reveal any abnormalities. However, an abnormal thromboelastography (TEG) value suggested primary hyperfibrinolysis, which led to a change in medical management. The patient did not suffer any further bleeding episodes after the change in treatment.

The authors discuss a case where TEG influenced patient management and identified a problem despite normal values of standard laboratorytests. Neurosurgeons should be aware of the potential benefits for TEG testing in pediatric patient3).

References

1)

Albert V, Subramanian A, Pati HP, Agrawal D, Bhoi SK. Efficacy of Thromboelastography (TEG) in Predicting Acute Trauma-Induced Coagulopathy (ATIC) in Isolated Severe Traumatic Brain Injury (iSTBI). Indian J Hematol Blood Transfus. 2019 Apr;35(2):325-331. doi: 10.1007/s12288-018-1003-4. Epub 2018 Aug 11. PubMed PMID: 30988571; PubMed Central PMCID: PMC6439129.
2)

McTaggart RA, Choudhri OA, Marcellus ML, Brennan T, Steinberg GK, Dodd RL, Do HM, Marks MP. Use of thromboelastography to tailor dual-antiplatelet therapy in patients undergoing treatment of intracranial aneurysms with the Pipeline embolization device. J Neurointerv Surg. 2015 Jun;7(6):425-30. doi: 10.1136/neurintsurg-2013-011089. Epub 2014 Apr 16. PubMed PMID: 24739599.
3)

Fulkerson DH, Weyhenmeyer J, Archer JB, Shaikh KA, Walsh M. Thromboelastography-Guided Therapy of Hemorrhagic Complications after Craniopharyngioma Resection: Case-Based Update. Pediatr Neurosurg. 2019 Aug 7:1-8. doi: 10.1159/000501117. [Epub ahead of print] Review. PubMed PMID: 31390646.
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