Reproducibility of TEG Parameters in Stable Cirrhotics.

BACKGROUND: Thromboelastography (TEG) has become the standard of care in liver-transplant surgery to identify real-time abnormalities in the coagulation cascade. To our knowledge, no studies have been performed to measure the intrasubject reproducibility of TEG parameters in cirrhotic patients. OBJECTIVE: To perform a validation study to determine the reproducibility of TEG in cirrhosis. METHODS: We recruited 30 patients with stable cirrhosis and tested 25 of them. Two blood specimens were drawn 1 hour apart; we measured the TEG parameters R time, K time, angle, maximum amplitude (MA), and functional fibrinogen (FF), along with conventional coagulation parameters. Reproducibility was assessed using the intraclass coefficient test. The TEG parameters were then compared with conventional coagulation test results. RESULTS: The K time, angle, MA, and FF results showed excellent reproducibility (r > 0.7; P <.001). Platelets and fibrinogen correlated with MA and K time; prothrombin time (PT) and activated partial thromboplastin time (aPTT) were inversely correlated with MA. CONCLUSION: All parameters were reproducible when measured 1 hour apart. TEG may be suitable to investigate coagulation characteristics in patients with clinically stable cirrhosis; however, further studies are needed in patients with more advanced cirrhosis, in whomblood product use may be more prevalent.

A new era of thromboelastometry / A nova era da tromboelastometria

ABSTRACT Severe hemorrhage with necessity of allogeneic blood transfusion is common complication in intensive care unit and is associated with increased morbidity and mortality. Prompt recognition and treatment of bleeding causes becomes essential for the effective control of hemorrhage, rationalizing the use of allogeneic blood components, and in this way, preventing an occurrence of their potential adverse effects. Conventional coagulation tests such as prothrombin time and activated partial thromboplastin time present limitations in predicting bleeding and guiding transfusion therapy in critically ill patients. Viscoelastic tests such as thromboelastography and rotational thromboelastometry allow rapid detection of coagulopathy and goal-directed therapy with specific hemostatic drugs. The new era of thromboelastometry relies on its efficacy, practicality, reproducibility and cost-effectiveness to establish itself as the main diagnostic tool and transfusion guide in patients with severe active bleeding.

RESUMO A hemorragia grave com necessidade de transfusão de sangue e componentes é uma complicação frequente na unidade de terapia intensiva e está associada ao aumento da morbidade e da mortalidade. A identificação adequada e o tratamento precoce da causa específica da coagulopatia tornam-se fundamentais para o controle efetivo da hemorragia, racionalizando a utilização de sangue e componentes, e desta forma, prevenindo a ocorrência de efeitos adversos. Testes convencionais da coagulação (tempo de ativação de protrombina e tempo de tromboplastina parcial ativada) apresentam limitações para prever sangramento e guiar a terapia transfusional em pacientes graves. Testes viscoelásticos como a tromboelastografia e tromboelastometria rotacional permitem a rápida detecção da coagulopatia e orientam a terapia de forma individualizada, alvo dirigida com drogas hemostáticas específicas. A nova era da tromboelastometria confia na sua eficácia, praticidade, reprodutibilidade e custo-eficácia para se firmar como a principal ferramenta diagnóstica e guia transfusional em pacientes com sangramento ativo grave.

A new era of thromboelastometry.

Severe hemorrhage with necessity of allogeneic blood transfusion is common complication in intensive care unit and is associated with increased morbidity and mortality. Prompt recognition and treatment of bleeding causes becomes essential for the effective control of hemorrhage, rationalizing the use of allogeneic blood components, and in this way, preventing an occurrence of their potential adverse effects. Conventional coagulation tests such as prothrombin time and activated partial thromboplastin time present limitations in predicting bleeding and guiding transfusion therapy in critically ill patients. Viscoelastic tests such as thromboelastography and rotational thromboelastometry allow rapid detection of coagulopathy and goal-directed therapy with specific hemostatic drugs. The new era of thromboelastometry relies on its efficacy, practicality, reproducibility and cost-effectiveness to establish itself as the main diagnostic tool and transfusion guide in patients with severe active bleeding.

Comparison of the international normalized ratio levels obtained by portable coagulometer and laboratory in a clinic specializing in oral anticoagulation.

INTRODUCTION: Therapy with Vitamin K antagonists (VKA) is effective in reducing thromboembolic events in various diseases. There are limitations however, which limit clinical handling and maintaining INR within therapeutic range. Studies have shown that portable coagulometers, when compared to laboratory tests, are more practical and provide better patient adherence and involvement toward treatment which results in better INR control. This study aimed to evaluate laboratory obtained INR results compared to two different portable coagulometers. METHODS: A prospective study which monitored 1009 patients using VKA in the Anticoagulation Clinic at the Institute Dante Pazzanese of Cardiology in São Paulo between July and September 2012. Patient INR values were obtained by the laboratory through venipuncture and then compared to INR values obtained by capillary puncture from two different portable coagulometers. RESULTS: Overall, 1009 patients were included in the study; among these, 520 (51.5%) are male with average age of 59.6 years (13-91). The more common indications were atrial fibrillation (49.9%) and mechanical prosthesis (33.7%). The correlation coefficient was of 0.95 with and 0.88 with INRatio PT Monitor(®) compared to laboratory. In patients with INR < 2 (lower than therapeutic range), the coefficient was 0.92 and 0.81 for CoaguChek XS plus(®) and INRatio PT Monitor(®) respectively. In patients within therapeutic range (INR 2-3), the coefficient was 0.86 with CoaguChek XS Plus(®) and 0.76 with INRatio PT Monitor(®) . For INR above therapeutic range (INR > 3.0) the correlation was 0.80 with CoaguChek XS Plus(®) and 0.54 with INRatio PT Monitor(®) . As for concordance between methods, the intraclass correlation coefficients (ICC) were slightly smaller than those previously stated (ICC = 0.899 with CoaguChek XS Plus(®) and ICC = 0.716 with INRatio PT Monitor(®) ). CONCLUSION: The use of portable coagulometers was comparable to laboratory tests and better correlation coefficients were observed with CoaguChek XS Plus(®) and in patients with INR lower or within therapeutic range. Portable coagulometers proved to be a useful and reliable tool for INR control in patients using VKA.