Thromboelastography Parameter and Its Association with Survival of COVID-19 Patients: A Retrospective Cross-Sectional Study

@#Introduction: Coagulopathy associated with Coronavirus disease 2019 (COVID-19) may cause life-threatening complications, especially in severe or critically ill COVID-19 patients. Thromboelastography (TEG) is an effective, dynamic, and reliable test to assess the complete coagulation process. This study aimed to determine the association between selected TEG parameters and survival in COVID-19 patients. Methods: This study was a retrospective observational study using data from medical records of COVID-19 patients who were hospitalized in Dr. Soetomo Hospital, Surabaya, Indonesia. There were 94 COVID-19 patients consisting of 76 survivors and 18 non-survivors. The association between TEG results and certain TEG parameters with survival status was considered significant if the p-value ≤ 0.05. Results: Increased coagulation activity had a significant association with the survival status of COVID-19 patients (p=0.04). There were no significant differences in all TEG parameters between COVID-19 patients who survived and those who did not survive (p > 0.05). Based on the TEG analysis tree, the most TEG results found were secondary fibrinolysis (21.3%) and fibrinolytic shutdown (24.5%). No significant association was found between the coagulability and fibrinolysis abnormality with the survival status in COVID-19 patients (p > 0.05). Conclusion: There was no significant difference in TEG results between COVID-19 survivors and non-survivors. However, based on the TEG result, an increase in coagulation activity is associated with a lower survival rate. Further study with detailed timing of TEG examination, disease severity and comorbidities stratification in COVID-19 patients may be needed.

Predictive value of thromboelastography combined with conventional coagulation tests for deep vein thrombosis in preoperative trauma patients / 中华急诊医学杂志

Objective:To analyze the relationship between preoperative deep vein thrombosis (DVT) and parameters of conventional coagulation tests (CCTs) and thromboelastography (TEG) in patients with acute trauma, and to establish a prediction model to screen out high-risk patients with preoperative DVT.Methods:The clinical data of patients with acute traumatic fracture admitted to the Emergency Intensive Care Unit of Shanghai Sixth People’s Hospital from January 2021 to June 2021 were retrospectively collected. According to whether preoperative DVT occurred, the patients were divided into the DVT group and non-DVT group. The differences of CCTs and TEG parameters at the same time were compared between the two groups. Logistic regression analysis was applied to identify independent risk factors for DVT after trauma. The receiver-operating characteristic curve analysis was employed to analyze the clinical value of those parameters to predict preoperative DVT.Results:Among 123 patients with acute traumatic fracture, 101 patients were treated with anticoagulation before operation, and 51 patients were diagnosed with DVT. There were significant differences in activated partial thromboplastin time, fibrinogen (Fib), D-Dimer, fibrinogen degradation products (FDPs), reaction time, clotting time, α angle, maximum amplitude (MA) and coagulation index between the DVT and non-DVT groups. D-Dimer and MA were independent risk factors for preoperative DVT in patients with traumatic fracture. Logistic regression equation was used to establish a prediction model: the predicting index = 0.101×D-Dimer +0.241×MA + (-18.190). The α angle (AUC=0.833, P<0.001), MA (AUC=0.904, P<0.001), coagulation index (AUC=0.914, P<0.001) of TEG versus Fib (AUC=0.684, P=0.001), D-Dimer (AUC=0.685, P<0.001) and FDPs (AUC=0.656, P=0.003) of CCTs had a higher diagnostic efficacy in developing DVT of lower extremity in patients with traumatic fracture, and of all the coagulation index was the best. However, the predictor of D-Dimer combined with MA had a better predictive value (AUC=0.926, P<0.001), and the best cut-off value was 0.32 with a sensitivity and specificity of 90.2% and 79.8%, respectively. Conclusions:Compared with CCTs, TEG has more advantages in predicting preoperative DVT in patients with traumatic fracture, and the predictor of D-Dimer combined with MA can screen out patients with high risk of DVT, which can be recommended for clinical application.

Tromboelastografía para cirugía general / Thromboelastography for general surgery

Resumen: Las pruebas convencionales de coagulación evalúan el tiempo en que los factores de coagulación se activan en el plasma sanguíneo, el cual carece de componentes celulares, como enzimas y plaquetas que intervienen en el desarrollo de la hemostasia. La tromboelastografía (TEG) realiza un análisis in vitro de la relación entre plaquetas, enzimas, fibrinógeno y otros elementos de la coagulación de manera integral; por lo que se utiliza con mayor frecuencia en cirugías cardíacas, trasplantes y cirugías de malformaciones arteriovenosas, donde la pérdida sanguínea esperada es mayor a 40% del volumen sanguíneo circulante. La inclusión de la TEG en la valoración preanestésica permite evaluar la actividad plaquetaria en los pacientes que utilizan antiagregantes, como clopidogrel o ácido acetilsalicílico, a través del mapeo plaquetario (Platelet Mapping®). Cuando se presenta hemorragia en el período transanestésico, la TEG permite identificar de manera específica el tipo de tratamiento necesario para mejorar la coagulación o la transfusión de elementos formes de la sangre. La TEG permite realizar protocolos más sofisticados de terapia transfusional, lo que implica una disminución de las complicaciones asociadas con la politransfusión y, por ende, la disminución de costos, por lo que estos beneficios justifican el uso rutinario de la TEG para cualquier cirugía general.

Abstract: Conventional coagulation tests evaluate the time in which the coagulation factors are activated in the blood plasma, which lacks cellular components such as enzymes and platelets that are involved in the development of hemostasis. Thromboelastography (TEG) performs an in vitro analysis of the relationship between platelets, enzymes, fibrinogen, and other coagulation elements in an integral way; reason why it is used more frequently in cardiac surgeries, transplants, and surgeries of arteriovenous malformations, where the expected blood loss is greater than 40% of the circulating blood volume. The inclusion of TEG in the pre-anesthetic evaluation allows evaluating platelet activity in patients who use antiplatelets therapy, such as clopidogrel or acetylsalicylic acid, through platelet mapping (Platelet Mapping®). When bleeding occurs in the trans-anesthetic period, TEG specifically identifies the type of treatment necessary to improve coagulation or transfusion of formed blood elements. The TEG allows more sophisticated transfusion therapy protocols to be carried out, which implies a decrease in complications associated with polytransfusion and a reduction in costs, so these benefits justify the routine use of TEG for any general surgery.

Correlation betweenthromboelastography and routine coagulation tests in malignant tumor patients / 中国输血杂志

【Objective】 To investigate the correlation between preoperative thromboelastography (TEG) parameters and routine coagulation tests of malignant tumor patients. 【Methods】 A total of 79 patients with malignant tumors, receiving preoperative TEG tests and routine coagulation tests between January 2019 and June 2020, were included. The correlation and regression between coagulation indexes and TEG parameters were analyzed. 【Results】 In patients with malignant tumors, the coagulation time(K) was negatively correlated with Plt and fibrinogen (FIB), while Angle, Ma, and G were respectively positively correlated with Plt and FIB. 【Conclusion】 There is a correlation between preoperative TEG parameters and routine coagulation tests in patients with malignant tumors. There is complementarity but not reciprocal substitutability between these two tests.

Establishment of Thromboelastography reference interval for healthy adults in Hainan / 中国输血杂志

【Objective】 To establish the reference interval of Thromboelastography(TEG)of healthy adult in Hainan, compare with the interval provided by the manufacturers, and analyze the influencing factors. 【Methods】 A total of 308 healthy adult volunteers were included according to the inclusion and exclusion criteria. The TEG was analyzed based on adequate quality control, and the reference interval of each parameter was calculated with 95% CI. 【Results】 The reference interval of these volunteers were R 4.27~9.20 min, K 1.60~3.83 min, Angle 44.22°~67.78°, MA 47.82~64.17 mm, CI -5.63~1.12 and G 4.58~9.03. 14.94% (46/308) of these volunteers had at least one index exceeded the reference interval provided by manufacturers. A total of 74 healthy volunteers were diagnosed with coagulation disorder, with the specificity at 79.22%. Significant differences of R, K, Angle, MA, CI, G were observed between males and females (P<0.05). Hypercoagulability was not associated with the age. 【Conclusion】 This study established a reference interval of TEG of healthy adults in Hainan, which provided reference for related clinical and basic science study.

Relationship between clopidogrel responsiveness and CYP2C19 genotype by thromboelastography in patients with coronary heart disease after PCI / 中国输血杂志

【Objective】 To explore the relationship between clopidogrel responsiveness and CYP2C19 gene polymorphism by thromboelastography(TEG) after PCI in patients with coronary heart disease, and its guiding significance for the use of clopidogrel after PCI. 【Methods】 A total of 246 patients who underwent PCI surgery in our hospital from June 2018 to May 2021 and routinely took clopidogrel maintenance treatment after the operation were selected.The platelet inhibition rate of the patients was detected by TEG to obtain their response to clopidogrel.The CYP2C19 genotype was detected, and the relationship between the patient′s responsiveness to clopidogrel and the CYP2C19 genotype was analyzed. 【Results】 The CYP2C19 genotypes in 246 patients were fast metabolizer (n=95), intermediate metabolizer (n=104) and slow metabolizer (n=47), with the mean ADP inhibition rate(%) at 46.27±21.41, 40.99±25.53 and 24.77±21.68, respectively.They were divided into clopidogrel resistant group (n=98) and clopidogrel normal response group (n=148). The three groups of patients with different CYP2C19 genotypes had no statistically significant differences in gender composition, age and platelet count (P>0.05), while significant differences in hypertension, diabetes and hyperlipidemia(P0.05), but they were all lower than those with slow metabolism patients (both P0.5). Statistically significant difference was noticed in the low responsiveness to clopidogrel by different CYP2C19 genotypes (P<0.05). The drug responsiveness of clopidogrel measured by TEG had strong correlation with the patient′s CYP2C19 genotype.When the ADP inhibition rate was the best cut-off value (27.10%), the sensitivity and specificity of CYP2C19 genotype being diagnosed as the slow metabolite type, was 73.37% and 70.21%, respectively. 【Conclusion】 The response of clopidogrel after PCI in patients with coronary heart disease is associated with CYP2C19 genotype polymorphism.The use of TEG to detect the ADP inhibition rate of patients has strong predictive effect on CYP2C19 genotype and has guiding significance on antiplatelet therapy in patients with coronary heart disease after PCI.

The clinical study of thromboelas-tography combined with coagulation four items and platelet count to guide platelet transfusion in critically ill patients / 中国输血杂志

【Objective】 To explore the clinical value of thromboelas-tography, coagulation four items and platelet count in guiding platelet transfusion in critically ill patients. 【Methods】 A total of 188 critically ill patients in Intensive Care Unit of our hospital from January 2020 to January 2022 were selected as subjects, and were divided into study group(n=89) and the control(n=99) according to the presence of bleeding symptoms. T-test was used for comparative analysis between the two groups. Spearman was used to analyze the correlation between TEG, coagulation four items and platelet count, and binary Logistic regression analysis was used to predict the influential factors of bleeding in critically ill patients, ROC curve was used to analyze the guiding value of the above-mentioned indexes for platelet transfusion. 【Results】 1) K and PT values in the study group, above the normal range, were significantly higher than those in the control, while the Angle value, MA value, CI value, FIB value and platelet count were significantly lower than those of the control, among which MA value, CI value and platelet count were below the normal range. 2) TEG, coagulation four items and platelet count were correlated. MA and CI values were positively correlated with platelet count, instead, R and K values were negatively correlated. R value was positively correlated with PT and APTT, CI value, on the contrary, was negatively correlated, K value was positively correlated with PT, while Angle value and MA value were negatively correlated. 3) Binary Logistic regression analysis showed that decreased MA value and decreased platelet count were independent risk factors for predicting bleeding in critically ill patients(P<0.05). 4) ROC curve analysis showed that the areas under ROC curve corresponding to Angle value, MA value, CI value, FIB value and platelet count were 0.866, 0.932, 0.9, 0.838 and 0.987(P<0.05). The sensitivity was highest in platelet count and lowest in FIB. The specificity was highest in MA and lowest in Angle. Compared with the single index, the area under the curve of the combined index(K value, MA value, CI value, PT value and platelet count) was 0.995(P<0.05), Yoden index 0.944, sensitivity 100%, specificity 93.3%, all higher than the individual index. 【Conclusion】 Thromboelas-tography combined with coagulation four items and platelet count can be used to accurately predict the critically ill patients with bleeding risk. To guide clinical platelets transfusion, the combined use of indexes, including K value, MA, CI value, PT and platelet count, is superior to separate use of them as the former showed better sensitivity and specificity, demonstrating a good clinical value.

Clinical effect of Fumai Zhuyu Decoction in the adjuvant treatment of deep vein thrombosis after orthopedic surgery / 国际中医中药杂志

Objective:To evaluate the curative effect of Fumai Zhuyu Decoction on deep vein thrombosis (DVT) after orthopedic surgery.Methods:According to random method, 90 patients with DVT after orthopedic surgery who met inclusion criteria in the hospital were divided into two groups between January 2018 and December 2020, 45 cases in each group. Both groups were given DVT catheterization for thrombolysis. After that, control group was given subcutaneous injection of low molecular weight heparin calcium, while observation group was additionally treated with Fumai Zhuyu Decoction. All were continuously treated for 14d. Before and after treatment, scores of TCM syndromes were evaluated. The coagulation response time (R), clotting time (K), clotting angle (α) and maximum strength of blood clotting (MA) were detected by full-automatic thromboelastometry analyzer. The levels of serum IL-6 and CRP were detected by ELISA. The hematocrit (Hct) was calculated according to red cell casts and whole blood height. The adverse reactions were recorded. And the clinical curative effect was evaluated.Results:The differences in total response rate between observation group and control group were statistically significant [82.2% (37/45) vs. 62.2% (38/45); χ2=4.49, P=0.034]. After treatment, scores of affected limb pain, dark encrusted skin and affected limb swelling in observation group were significantly lower than those in control group ( t values were 7.26, 7.14, 6.88, respectively, all Ps<0.001). After treatment, R [(6.12±0.86) min vs. (5.45±0.56) min, t=3.58] and K [(2.24±0.45) min vs. (1.72±0.42) min, t=4.63] in observation group were significantly longer than those in control group ( P<0.01), α [(51.69±2.23)° vs. (54.23±2.42)°, t=4.23] and MA [(51.58±3.62) min vs. (54.58±3.53) min, t=3.25] were significantly lower than those in control group ( P<0.01), and levels of serum IL-6, CRP and Hct were significantly lower than those in control group ( t values were 2.66, 2.96, 7.58, respectively, all Ps<0.01). During treatment, differences in incidence of adverse reactions between observation group and control group were statistically significant [6.7% (3/45) vs. 22.2% (10/45); χ2=4.41, P=0.036]. Conclusion:The Fumai Zhuyu Decoction can reduce blood viscosity, prevent thrombosis and improve clinical curative effect in patients with DVT after orthopedic surgery.

Effects of thromboelastography guided blood transfusion on blood potassium, coagulation parameters and prognosis in patients with post-traumatic massive hemorrhage / 中国医师进修杂志

Objective:Analyze the influence of blood transfusion therapy under the guidance of thromboelastography on the blood potassium and coagulation indicators and prognosis of patients with post-traumatic hemorrhage.Methods:The clinical data of 73 patients with post-traumatic hemorrhage in Liyang People′s Hospital from March 2018 to February 2021 were retrospectively analyzed. Among them, TEG blood transfusion guidance group (group A) and conventional coagulation indicator guidance group (group B) were divided according to whether TEG test was performed. Repeated measurement analysis of variance and post LSD- t test were used to observe serum potassium, coagulation indexes and prognosis of 2 groups at each time point. Results:The amount of various drugs used in group A was significantly lower than that in group B ( P<0.05). Comparison of serum potassium levels between the two groups before transfusion: (3.94 ± 0.85) mmol/L vs. (3.98 ± 0.71) mmol/L; and on the first day after transfusion: (4.33 ± 0.48) mmol/L vs. (4.57 ± 0.73) mmol/L, there were statistically significant ( P<0.05); on day one. day two and day three after blood transfusion, the indexes of PT and APTT in group A were significantly lower than those in group B: PT: (14.30 ± 1.43) s vs. (16.25 ± 1.74) s, (14.41 ± 1.55) s vs. (16.27 ± 1.48) s, (14.73 ± 1.50) s vs. (16.30 ± 1.45) s; APTT: (32.3 ± 3.6) s vs. (36.7 ± 3.5) s, (32.6 ± 3.4) s vs. (36.8 ± 3.6) s, (32.2 ± 3.2) s vs. (36.3 ± 3.3) s; the above indexes of the two groups before treatment were significantly higher than those at each time point after treatment ( P<0.05). The total effective rate of hemostasis in group A was higher than that in group B: 97.37%(37/38) vs. 80.00%(28/35), P<0.05. Conclusions:Patients with post-traumatic hemorrhage can be recovered by blood transfusion under the guidance of thromboelastography, and the disorder of blood coagulation indicators can be restored, and at the same time, it has a better hemostatic effect.

Prevention of Deep Vein Thrombosis by Panax Notoginseng Saponins Combined with Low-Molecular-Weight Heparin in Surgical Patients / 中国结合医学杂志

OBJECTIVE@#To evaluate the efficacy of deep vein thrombosis (DVT) prevention among real-world surgical inpatients who received panax notoginseng saponins (PNS) combined with low-molecular-weight heparin (LMWH).@*METHODS@#A prospective cohort study was conducted among surgical patients between January 2016 and November 2018 in Xuanwu Hospital, Capital Medical University, Beijing, China. Participants received LMWH alone or PNS combined with LMWH for preventing DVT. The primary outcome was incidence of lower extremity DVT, which was screened once a week. Participants in the LMWH group were given LMWH (enoxaparin) via hypodermic injection, 4000-8000 AxalU once daily. Participants in the exposure group received PNS (Xuesaitong oral tablets, 100 mg, 3 times daily) combined with LMWH given the same as LMWH group.@*RESULTS@#Of the 325 patients screened for the study, 281 participants were included in the final analysis. The cohort was divided into PNS + LMWH group and LMWH group with 134 and 147 participants, respectively. There was a significant difference of DVT incidence between two groups (P=0.01), with 21 (15.7%) incident DVT in the PNS + LMWH group, and 41 (27.9%) incident DVT in the LMWH group. Compared with participants without DVT, the participants diagnosed with DVT were older and had higher D-dimer level. The multivariate logistic regression model showed a significant lower risk of incident DVT among participants in the PNS + LMWH group compared with the LMWH group (odds ratio 0.46, 95% confidence interval, 0.25-0.86). There were no significant differences in thromboelaslography values (including R, K, Angle, and MA) and differences in severe bleeding between two groups. No symptomatic pulmonary embolism occurred during the study.@*CONCLUSION@#Combined application of PNS and LMWH can effectively reduce the incidence of DVT among surgical inpatients compared with LMWH monotherapy, without increased risk of bleeding.

Comparative Analysis of Thromboelastogram and Coagulation Items in Mongolian Patients with Thrombosis / 中国实验血液学杂志

OBJECTIVE@#To investigate the age distribution of Mongolian patients with cerebral infarction caused by thrombosis and the correlation and consistency between thromboelastography (TEG) and four parameters of coagulation.@*METHODS@#The age distribution of 298 Mongolian patients with cerebral infarction treated in Affiliated Hospital of Inner Mongolia Minzu University from January 2020 to December 2021 and their TEG, four items of routin coagulation and platelet count were analyzed retrospectively. The correlation and consistency of above-mentioned two detection methods were statistically analyzed.@*RESULTS@#The onset age of 298 Mongolian patients with cerebral infarction was mainly 61-70 years old, accounting for 38.3%, followed by 51-60 years old, accounting for 26.8%. The R time detected by TEG was linearly correlated with PT and APTT（r=0.186，r=0.152）. K value, MA value and α-Angle measured by TEG was linearly correlated with Fib (r=-0.364，r=0.616，r=0.359), K value, MA value and α-Angle measured by TEG was linearly correlated with Plt (r=0.318，r=0.519，r=0.301). The R time detected by TEG was consistent with PT and APTT, and the Kappa values were 0.252 (P<0.001), 0.336 (P<0.001). K, MA, and α-Angle measured by TEG was consistent with Fib, the Kappa values were 0.265 (P<0.001), 0.289 (P<0.001) and 0.290 (P<0.001), respectively; K、MA and α-Angle measured by TEG was consistent with Plt, the Kappa values were 0.276 (P<0.001), 0.285 (P<0.001) and 0.302 (P<0.001), respectively.@*CONCLUSION@#The onset age of Mongolian patients with cerebral infarction caused by thrombosis is mainly 61-70 years old, followed by 51-60 years old. The onset age shows a younger trend. There is a significant correlation between TEG and coagulation, but the consistency is weak, therefore, the two methods can not be replaced each other.

Application of platelet GPⅡb/Ⅲa receptor inhibitor (A adjuvant) in the detection of platelet aggregation function / 中国输血杂志

【Objective】 To evaluate the effect of adding platelet GPⅡb/Ⅲa receptor inhibitor (A adjuvant) into the Batroxobin cup (A cup) on the accuracy of the thromboelastogram (TEG) platelet aggregation function test using the functional fibrinogen (function fiber cup) test results as a standard. 【Methods】 From December 2019 to May 2020, 100 (persons) whole blood samples were collected from patients who visited the Department of Neurology, Department of Cardiology, Department of General Affairs and Department of Rehabilitation of our hospital for TEG platelet aggregation function test, and the blood standard samples were divided into MA <25 mm group (n=50) and MA≥25 mm group (n=50) according to the A-cup blood clot intensity (MA) value (mm) measured by TEG, the two groups were subdivided into A cup group (n=50, respectively), A auxiliary group (adding A auxiliary in A cup) (n=50, respectively), and functional fiber cup group (n=50, respectively), each subgroup was tested once again. The linear correlation, platelet inhibition and the consistency of drug efficacy interpretation results in platelet Adenosine diphosphate (ADP) and Arachidonic acid (AA) pathway respectively between the three subgroups were compared. 【Results】 (1) In the MA<25mm group, the inhibition rates of ADP and AA pathway in platelet of A cup, A adjuvant and functional fibrin cup subgroups were (32.00±17.44) % vs (30.19±17.44) % vs (30.07±16.18) %, (24.3±33.53) % vs (22.53±30.9) % vs (22.37±31.2) %, respectively (R2 were all>0.975); (2) In the MA≥25 mm group, the inhibition rates of ADP and AA pathway in platelet of A cup, A adjuvant and functional fibrin cup subgroups were (34.34±33.59) % vs (18.45±24.42) % vs (18.01±24.33) %, (23.19±39.33) % vs (8.48±21.75) % vs (8.31±21.7) % ( R2 between the A cup group and the A adjuvant group were all<0.8, and R2 between the A adjuvant group and the functional fibrinogen cup group were all >0.975); (3)Take the test result of the functional fibrinogen cup as the standard, the correct rates of ADP and AA pathway drug efficacy interpretation were 82% (41/50) vs 100% (50/50) and 84% (42/50) vs 100% (50/50) respectively (P<0.05) between the A-cup group and the A adjuvant group, while the interpretation results of drug efficacy of the two pathway were consistent between the A adjuvant group and the functional fibrin cup group (P>0.05). 【Conclusion】 Adding A adjuvant to TEG platelet aggregation function test can effectively inhibit non-specifically activated platelets in the A cup in the detection of platelet aggregation function, truly reflect the function of fibrinogen and improve the accuracy of platelet inhibition rate.

Westgard multi-rule control method combined with Levey-Jennings quality control chart in daily indoor quality control of TEG / 中国输血杂志

【Objective】 To continuously improve the routine indoor quality and precision of TEG by applying Westgard multi-rule control method combined with Levey-Jennings quality control chart. 【Methods】 The parameters R, K, Angel and MA of TEG were monitored and analyzed in the laboratory for 12 consecutive months using the same batch of quality control products via Westgard multi-rule control method combined with Levey-Jennings quality control chart, and the mean(), standard deviation (SD) and coefficient of variation (CV%) were calculated to observe the control effect. 【Results】 We applied this quality control method to timely correct, analyze and improve the system errors in TEG indoor quality control.The CV% value of R, K, Angle and MA were 20.33%, 13%, 3.6% and 9.65%, respectively, during January to June 2019, but decreased to 9%, 3%, 1.28% and 5.35%, respectively, during July to December 2019. 【Conclusion】 The application of Westgard multi-rule control method and Levey-Jennings quality control chart in TEG indoor quality control test can improve the precision of TEG clinical test results.

The role of thromboelastography in diagnosis and treatment of PICC related venous thrombosis in tumor patients / 中国输血杂志

【Objective】 To investigate the role of thromboelastography (TEG) in the diagnosis and treatment of PICC related venous thrombosis in tumor patients, and provide basis for predicting PIC related venous thrombosis. 【Methods】 148 tumor patients who underwent PICC catheterization in our hospital from January to July 2019 were enrolled. The patients were subjected to TEG examination and ultrasound examination of limb blood vessels on catheterization side regularly one day before catheterization and 4 successive weeks after catheterization(once a week), respectively. The patients with venous thrombosis were subjected to TEG examination and vascular ultrasound regularly for 3 successive weeks(once a week) after anticoagulant therapy. The relationship between the occurrence and time of venous thrombosis and the changes of TEG parameters was analyzed. 【Results】 The pre-/post-catheterization TEG parameter of 81 patients without venous thrombosis indicated that coagulation state was normal (R value F=0.198, K value F=0.047, α value F=0.442, MAvalue F=0.079, CIvalue F=0.026, P>0.05). The TEG parameter of 67 patients, who developed asymptomatic venous thrombosis 1 to 3 weeks after catheterization(38 cases in 1 week, 16 in 2 weeks and 13 in 3 weeks), indicated the blood was hypercoagulable and the TEG parameter was statistically different from the pre-catheterization value(P0.05). 【Conclusion】 TEG can reflect the status of PICC related venous thrombosis in tumor patients.Strengthening TEG monitor in tumor patients 1 to 3 weeks after PICC catheterization is conducive to early detection, diagnosis and treatment for PICCrelated thrombosis, thus reducing the harm of venous thrombosis to patients.

Evaluation and comparison of thromboelastography and conventional coagulation tests for blood coagulation function in children with Kasabach-Merritt syndrome / 中国输血杂志

【Objective】 To evaluate the coagulation function of children with Kasabach-Merritt syndrome(KMS)by thromboelastography (TEG) and conventional coagulation tests (CCTs), and to explore the correlation and consistency of the 2 test methods. 【Methods】 A total of 49 children with KMS, submitted to our hospital from January 2016 to December 2020, were enrolled. The TEG, CCTs data and platelet count were analyzed to evaluate the coagulation function, and the superiority of the 2 test methods were compared by Spearman correlation and Kappa consistency analysis. 【Results】 TEG and CCTs showed that the coagulation reaction time(R) was normal, the counts and function of platelet and fibrinogen decreased, and the D-dimer increased. The coagulation complex index (CI) indicated that the whole coagulation function was low. There was no significant difference in coagulation by sex or age in KMS children. The correlation analysis of TEG and CCTs in the coagulation function of KMS children showed that R was correlated with prothrombin time (PT) and activated partial thromboplastin Time(APTT), respectively (P<0.01); Fib had weak correlation with clot formation time (k)(r2=0.33), but strongly correlated with α-angle and MA value(r2=0.7, 0.69), respectively (P<0.01). PLT was moderately correlated with MA(r2=0.49, P<0.05); D-dimer had no correlation with LY30. Comparision resu lts of the consistency of TEG and CCTs showed that FIB and MA had consistency ( kappa=1, P<0.01); None or weak consistency was noticed among other indicators, R with PT/APTT, the kappa was 0.18 and 0.19; Fib with K/α-Angle, the kappa was 0.28 and 0.34; D-dimer with LY30, the kappa was 0.01; PLT with MA, the kappa was 0.35. 【Conclusion】 The main manifestations in low coagulation function in children with KMS were mainly thrombocytopenia, lower fibrinogen, and increased fibrinogen degradation-products, and the coagulation factors were normal. Except for Fib and MA, the consistency of other indexes in the detection of coagulation function in children with KMS by TEG and CCT is weak. Some indexes are significantly correlated but others not. Therefore, the 2 test methods are irreplaceable and should be combined to reduce the risk of embolism and bleeding in children.

Comparison of thromboelastography and routine coagulation tests for evaluation of blood coagulation in critically ill children / 中国小儿急救医学

Objective:To investigate the correlation and consistency between the parameters of the thromboelastography(TEG) and of routine coagulation tests and platelet count(PLT) in critically ill children in the pediatric intensive care unit.Methods:We conducted a retrospective analysis on the results of the simultaneous TEGs, coagulation tests and PLT of 231 children in pediatric intensive care unit at Children′s Hospital Affiliated to Fudan University from March 2019 to July 2019, including the correlation analysis, the chi-square test and Kappa consistency analysis.Results:The reaction time(R) was linearly dependent on activated partial thromboplastin time(APTT), prothrombin time(PT) and thrombin time(TT), respectively.The maximal amplitude(MA), clot time formation(K) and alpha-angle(α) were linearly dependent on fibrinogen.The MA, K and α were linearly dependent on PLT, too.And the correlation between MA and PLT was the best( R=0.656). There were significant differences( P<0.001) and poor consistency(Kappa value: 0.112, 0.047, 0.124) between R and APTT, PT, TT.There was no significant difference( P>0.05) and there was moderate consistency(Kappa value: 0528, 0.518, 0.408) between Ma, K, α and PLT.There were significant differences( P<0.001) and the consistency was poor or fair(Kappa value: 0.324, 0.188, 0.170) between Ma, K, α and fibrinogen. Conclusion:TEG is significantly correlated with PLT in evaluating platelet function and the consistency is good.The TEG parameters are linearly correlated with the relevant results of routine coagulation tests in evaluating the coagulation factor and fibrinogen function, but consistency is weak.Therefore, it is concluded that these two methods are irreplaceable.

Role of thromboelastography in assessing the risk of spontaneous bleeding in patients with liver cirrhosis / 临床肝胆病杂志

ObjectiveTo investigate the association between thromboelastography (TEG) parameters and bleeding in patients with liver cirrhosis and whether TEG can be used to predict the risk of spontaneous bleeding in patients with liver cirrhosis, and to provide a basis for its preventive treatment. MethodsA retrospective analysis was performed for the clinical data of 174 patients with liver cirrhosis who attended Huadu People’s Hospital from May 2018 to April 2020 and did not receive invasive procedure, and according to the condition of bleeding, they were divided into non-bleeding group(n=64), gastrointestinal bleeding group(n=61), and mucocutaneous/oronasal bleeding group(n=49). The medical record system and laboratory information system were used to collect related information and laboratory test results for statistical analysis. The t-test was used for comparison of normally distributed continuous data between two groups; an analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between two groups. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups. MedCalc software was used for receiver operating characteristic (ROC) curve analysis, and the area under the ROC curve (AUC) was calculated for commonly used coagulation markers and TEG parameters in predicting the risk of bleeding in patients with liver cirrhosis. Cut-off value, sensitivity, specificity, positive predictive value, and negative predictive value were determined, and the Z test was used for comparison of indices in predicting mucocutaneous/oronasal bleeding. ResultsOf all 174 patients, 110 (63.2%) experienced spontaneous bleeding, among whom 61 (55.5%) had gastrointestinal bleeding and 49 (44.5%) had mucocutaneous/oronasal bleeding. There were significant differences in maximum amplitude (MA) and K between the bleeding group and the non-bleeding group (t=2.241 and -2.605, both P＜0.05). There were significant differences between the mucocutaneous/oronasal bleeding group and the non-bleeding/gastrointestinal bleeding groups in platelet count (PLT) and the TEG parameters of clot formation time, a-angle, MA, and coagulation index (CI) (F=3.947, H=12.867, F=4.007, F=8.498, F=5.420, all P＜0.05). Among the TEG parameters, reaction time and Lys30 were generally within the normal range, while there was a prolonged kinetics (K) time and reductions in a-angle, MA, and CI. PLT ≤40×109/L, MA ≤357 mm, K time ＞4.2 minutes, a-angle ≤51.6, and CI ≤-5.9 could be used to predict spontaneous mucocutaneous/oronasal bleeding in patients with liver cirrhosis (all AUC ＞0.7), with positive predictive values of 82.4, 88.9, 81.0, 72.7, and 73.7, respectively, and negative predictive values of 68.3, 72.5, 73.0, 69.4, and 66.7, respectively. ConclusionPLT and the TEG parameters of K time, a-angle, MA, and CI can predict spontaneous bleeding caused by abnormal coagulation in liver cirrhosis, while conventional coagulation parameters prothrombin time and activated partial thromboplastin time cannot predict such bleeding, which provides a basis for the treatment of coagulation disorder and transfusion of blood components for patients with liver cirrhosis.

A tromboelastometria identifica coagulopatia associada à insuficiência hepática e coagulação intravascular disseminada causadas por febre amarela, orientando a terapia hemostática específica: um relato de caso / Thromboelastometry identifies coagulopathy associated with liver failure and disseminated intravascular coagulation caused by yellow fever, guiding specific hemostatic therapy: a case report

RESUMO Este relato de caso detalha um caso grave de febre amarela complicada por insuficiência hepática e coagulação intravascular disseminada. A tromboelastometria foi capaz de identificar os distúrbios da coagulação e orientar o tratamento hemostático. Relatamos o caso de um homem com 23 anos de idade admitido na unidade de terapia intensiva com quadro com início abrupto de febre e dor muscular generalizada associados a insuficiência hepática e coagulação intravascular disseminada. Os resultados dos exames laboratoriais convencionais revelaram trombocitopenia, enquanto a tromboelastometria sugeriu coagulopatia com discreta hipofibrinogenemia, consumo de fatores de coagulação e, consequentemente, aumento do risco de sangramento. Diferentemente dos exames laboratoriais convencionais, a tromboelastometria identificou o distúrbio de coagulação específico e, assim, orientou o tratamento hemostático. Administraram-se concentrados de fibrinogênio e vitamina K, não sendo necessária a transfusão de qualquer componente do sangue, mesmo na presença de trombocitopenia. A tromboelastometria permitiu a identificação precoce da coagulopatia e ajudou a orientar a terapêutica hemostática. A administração de fármacos hemostáticos, incluindo concentrados de fibrinogênio e vitamina K, melhorou os parâmetros tromboelastométricos, com correção do transtorno da coagulação. Não se realizou transfusão de hemocomponentes, e não ocorreu qualquer sangramento.

Abstract This case report a severe case of yellow fever complicated by liver failure and disseminated intravascular coagulation. Thromboelastometry was capable of identifying clotting disorders and guiding hemostatic therapy. We report the case of a 23-year-old male admitted to the Intensive Care Unit with sudden onset of fever, generalized muscle pain associated with liver failure, and disseminated intravascular coagulation. The results of conventional laboratory tests showed thrombocytopenia, whereas thromboelastometry suggested coagulopathy with slight hypofibrinogenemia, clotting factor consumption, and, consequently, an increased risk of bleeding. Unlike conventional laboratory tests, thromboelastometry identified the specific coagulation disorder and thereby guided hemostatic therapy. Both fibrinogen concentrates and vitamin K were administered, and no blood component transfusion was required, even in the presence of thrombocytopenia. Administration of hemostatic drugs, including fibrinogen concentrate and vitamin K, improved thromboelastometric parameters, correcting the complex coagulation disorder. Blood component transfusion was not performed, and there was no bleeding.

Thromboelastography as an instrument of preclinical studies of the potential drug

There are no recommendations for assessing the effect of potential drugs on the hemostatic system irrespective of theanticipated application area, which leads to long-term financial losses. The examples of papaverine hydrochloride,pentoxifylline, and acetylsalicylic acid demonstrated the potential of thromboelastography (TEG) as a screening methodfor products that affect the hemostatic system, the safety assessment method for hypercoagulability/hypocoagulability,and the thrombosis model, using tissue factor (TF) or thrombin. The blood of male donor patients (n = 60) with acutede novo thrombosis (n = 90) was used. Using activated TEG, in vitro hemostatic system hyperactivity modeling wascarried out with the blood of healthy male donors (n = 20); 0.2 М CaCl2, recombinant TF, and thrombin were used asTEG activators. General coagulation tendency (R), functional activity of thrombocytes and fibrinogens (МА, Angle),fibrinolysis activity, and physical–mechanical properties of formed clots were determined from thromboelastograms.The effect of anti-aggregants was characterized by a significant decrease in МА. The potential of TEG as a screeningmethod for assessing the effect of new pharmacological agents on the hemostatic system at preclinical stage wasdemonstrated; the possibility of safety assessment for hypercoagulability/hypocoagulability was shown; and thecomparability of hemostatic parameters of the patients with thrombosis and TEG, activated by TF and/or thrombinwas demonstrated.

Thromboelastography-based assessment of coagulation function in patients with chronic kidney disease and the risk factors of hypercoagulability / 南方医科大学学报

OBJECTIVE@#To assess the changes in the coagulation profiles of patients with chronic kidney disease (CKD) using thromboelastography (TEG) and identify the risk factors of hypercoagulation in CKD patients.@*METHODS@#A total of 128 patients with CKD admitted in Hunan Provincial People's Hospital between August, 2018 and May, 2019 were recruited. The results of conventional coagulation test and TEG were compared between patients with CKD and 21 healthy control adults. The patients with CKD were divided into hypercoagulation group with a maximum amplitude (MA) > 68 mm (=66) and non-hypercoagulation group (MA≤68 mm, =62). The laboratory indicators were compared between the groups, and the factors affecting the hypercoagulable state in patients with CKD were analyzed.@*RESULTS@#The levels of fibrinogen and D-Dimer increased significantly in patients with CKD at different stages as compared with the control subjects ( < 0.05). In the patients with CKD, the reaction time and K time decreased while MA, α-angle and coagulation index increased significantly in patients in stage 3-4 and those in stage 5 either with or without hemodialysis compared with the control group ( < 0.05). The estimated glomerular filtration rate (eGFR), percentage of patients with diabetes mellitus, history of stroke, percentage of neutrophils, neutrophil-lymphocyte ratio, red blood cell count, hemoglobin levels, platelet count, serum creatinine, serum cystatin-C, serum albumin, and lipoprotein (a) all differed significantly between hypercoagulation group and non-hypercoagulation group ( < 0.05). The eGFR, platelet count and hemoglobin levels were identified as independent factors affecting hypercoagulability in patients with CKD ( < 0.05).@*CONCLUSIONS@#s The hypercoagulable state of patients with CKD worsens gradually with the disease progression, and eGFR, platelet count and hemoglobin levels are all risk factors for the hypercoagulable state in patients with CKD.