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 patients ³⁾.