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.

Comparing modified Lee and White method against 20-minute whole blood clotting test as bedside coagulation screening test in snake envenomation victims

Abstract Background: Twenty-minute whole blood clotting test (20WBCT) and Modified Lee and White (MLW) method are the most routinely employed bedside tests for detecting coagulopathic snake envenomation. Our study compared the diagnostic utility of MLW and 20WBCT for snakebite victims at a tertiary care hospital in Central Kerala, South India. Methods: This single-center study recruited 267 patients admitted with snake bites. 20WBCT and MLW were performed simultaneously at admission along with the measurement of Prothrombin Time (PT). The diagnostic utility of 20WBCT and MLW was determined by comparing the sensitivity (Sn), specificity (Sp), positive and negative predictive values, likelihood ratios, and accuracy at admission with an INR value > 1.4. Results: Out of 267 patients, 20 (7.5%) patients had VICC. Amongst those who had venom-induced consumption coagulopathy (VICC), MLW was prolonged for 17 patients, (Sn 85% 95% confidence interval [CI]: 61.1-96.0) whereas 20WBCT was abnormal for 11 patients (Sn 55%, 95% CI: 32.04-76.17). MLW and 20WBCT were falsely positive for the same patient (Sp 99.6%, 95% CI: 97.4-99.9%). Conclusion: MLW is more sensitive than 20WBCT to detect coagulopathy at the bedside amongst snakebite victims. However, further studies are necessary for standardizing bedside coagulation tests in snakebite cases.

The comparative study between thromboelastography and conventional coagulation tests in ischemic cerebral vascular disease / 中华急诊医学杂志

Objective@#To explore the correlation and consistency between thromboelastography (TEG) and traditional coagulation tests (CCTs) in ischemic cerebral vascular disease (ICVD).@*Methods@#Totally 108 ICVD patients admitted to Nanyang Central Hospital from May 1 to October 31 2018 were enrolled. Patients’ TEG parameters (R value, K value, Angle value, MA value, CI value and G value) and CCTs parameters (PT, APTT, TT, and FIB) were collected and analyzed retrospectively. The Spearman correlation coefficient was used to explore the correlation between TEG and CCTs parameters, and Kappa (κ) to explore the consistency in determining the coagulation status of the patients. The ROC curve was used to analyze the predictive value of TEG parameters for abnormal results of CCTs, and the results of TEG and CCTs were comprehensively analyzed to evaluate the ability to predict the coagulation status of patients.@*Results@#(1) PLT was positively correlated with MA value and G value; PT and APTT were positively correlated with K value; TT was positively correlated with R value and K value; FIB was positively correlated with Angle value, MA value and G value. TT was negatively correlated with Angle value and CI value; FIB was negatively correlated with K value. (2) PT and MA values, PT and G values, FIB and MA values, FIB and G values were accordant in valuing the hypoxic state of ICVD patients. (3) PLT and Angle values, PLT and MA values, PLT and CI values, PLT and G values were accordant in assessing hypercoagulable status of ICVD patients; FIB and Angle values, FIB and MA values, FIB and CI value, and FIB and G value were consistent in evaluating the hypercoagulable state of ICVD patients. (4) For detecting TT>20 s, the AUC of K value and Angle value were 0.648, 0.651, respectively; For detecting FIB>4 g/L, the AUC of Angle value and MA value were 0.717 and 0.747, respectively; For detecting PLT>300×109/L, the AUC of MA value was 0.808 (all P<0.05).@*Conclusions@#There is weak correlation and consistency between TEG and CCTs parameters in ICVD patients. The TEG parameters have good predictive value in evaluating the abnormal results of CCTs, but cannot replace the CCTs. Combination of these two methods can better reflect the coagulation status of patients, so as to afford assistance.

The comparative study between thromboelastograpby and conventional coagulation tests in ischemic cerebral vascular disease / 中华急诊医学杂志

Objective To explore the correlation and consistency between thromboelastograpby(TEG)and traditional coagulation tests(CCTs)in ischemic cerebral vascular disease(ICVD).Methods Totally 108 ICVD patients admitted to Nanyang Central Hospital from May 1 to October 31 2018 were enrolled.Patients' TEG parameters(R value,K value,Angle value,MA value,CI value and G value)and CCTs parameters(PT,APTT,TT,and FIB)were collected and analyzed retrospectively.The Spearman correlation coefficient was used to explore the correlation between TEG and CCTs parameters,and Kappa(κ)to explore the consistency in determining the coagulation status of the patients.The ROC curve was used to analyze the predictive value of TEG parameters for abnormal results of CCTs,and the results of TEG and CCTs were comprehensively analyzed to evaluate the ability to predict the coagulation status of patients.Results(1)PLT was positively correlated with MA value and G value; PT and APTT were positively correlated with K value; TT was positively correlated with R value and K value; FIB was positively correlated with Angle value,MA value and G value.TT was negatively correlated with Angle value and CI value; FIB was negatively correlated with K value.(2)PT and MA values,PT and G values,FIB and MA values,FIB and G values were accordant in valuing the hypoxic state of ICVD patients.(3)PLT and Angle values,PLT and MA values,PLT and CI values,PLT and G values were accordant in assessing hypercoagulable status of ICVD patients; FIB and Angle values,FIB and MA values,FIB and CI value,and FIB and G value were consistent in evaluating the hypercoagulable state of ICVD patients.(4)For detecting TT＞20 s,the AUC of K value and Angle value were 0.648,0.651,respectively;For detecting FIB＞4 g/L,the AUC of Angle value and MA value were 0.717 and 0.747,respectively; For detecting PLT＞ 300× 109/L,the AUC of MA value was 0.808(all P＜0.05).Conclusions There is weak correlation and consistency between TEG and CCTs parameters in ICVD Patients.The TEG parameters have good predictive value in evaluating the abnormal results of CCTs,but cannot replace the CCTs.Combination of these two methods can better reflect the coagulation status of patients,so as to afford assistance.

Thromboelastography:clinical applications and new development / 国际检验医学杂志

Under normal physiological conditions, hemostatic process is a dynamic balance process dependent on many factors.It involves interaction between primary hemostasis (vasoconstriction, platelet clot formation), secondary hemostasis (thrombin generation, fibrin polymerization) and fibrinolysis, and any abnormalities of the three may cause hemorrhagic or thrombotic diseases.Conventional coagulation tests are useful for a limited degree since they only reflect a portion of the coagulation cascade.Thromboelastography (TEG) provides a more complete picture of coagulation status, taking into account more factors involved in the clotting process, including platelet activity and clotting factors, which has been widely used in clinic.In this article, we will briefly discuss clinical applications and new development of TEG.

The comparative study between thromboelastography and conventional coagulation tests in critically ill patients of emergency department / 中华急诊医学杂志

Objective To explore the correlation and difference between thromboelastography (TEG) and conventional coagulation tests (CCTs) in critically ill patients of emergency department,so as to provide valuable information for TEG clinical application.Methods TEG and CCTs data of critically ill patients admitted from August 2015 to September 2016 in emergency department of Xijing Hospital were prospectively collected and retrospectively analyzed.The correlational analyses of analogue parameters of TEG and CCTs were carried out to investigate their clinical significance.ROC curve was used to explore the sensitivity and specificity of R for diagnosis of abnormal PT and APTT.Then comparisons of sensitivity of detecting abnormalities of clotting factors among R,PT and APTT were made.The changes of α and MA in patients with abnormal platelet count or fibrinogen concentration were respectively counted so as to evaluate the ability of oα and MA to reflect abnormal platelet count or fibrinogen concentration.The results of TEG and CCTs were comprehensively analyzed to find out the capability of TEG and CCTs in reflecting the overall blood coagulation status.The differece in blood transfusion rate was compared between TEG and CCTs in trauma patients.The chi-square test of matched fourfold table was used to test the significance and there was statistical significance when P ＜ 0.05.Results (1) R correlated weakly with PT and APTT,MA correlated moderately with FIB and PLT;K and α angle correlated moderately with PLT and weakly with FIB.For the TEG parameter,there was no correlation between R and MA.R correlated moderately with K,α,and K correlated strongly with α angle,MA,and α correlated strongly with MA.(2) For detecting PT ＞ 15.1 s,the sensitivity of R (＞ 10 min) was 32％ (95％ CI:0.20-0.47) and specificity was 90％ (95％CI:0.84-0.94).For detecting APTT ＞41.8 s,the sensitivity of R (＞ 10 min) was 39％ (95％ CI:0.25-0.54) and specificity was 91％ (95 ％ CI:0.85-0.95).(3) There was a low sensitivity for MA and α to detect PLT count or FIB concentration abnormality.(4) TEG was able to detect a few abnormal blood coagulation which CCTs could not detect.(5) TEG-guided transfusion reduced plasma transfusion ratein trauma patients.Conclusions There is a moderate or even weak correlation between TEG and CCTs parameters,R has a low sensitivity to detect abnormal blood coagulation factor than PT,APTT.TEG is mainly able to reflect functional abnormality of PLT and FIB rather than to reflect their quantitative changes.TEG is able to detect a few abnormal blood coagulation which CCTs are not able to detect.The use of TEG can reduces plasma transfusion rate in trauma patients.TEG has certain advantages over CCTs but is not able to completely replace CCTs.Individual component change and overall blood coagulation status can be assessed in their combination,suggesting more helpful for clinical diagnosis and treatment.

The comparative study between thromboelastography and conventional coagulation tests in critically ill patients of emergency department / 中华急诊医学杂志

Objective To explore the correlation and difference between thromboelastography (TEG) and conventional coagulation tests (CCTs) in critically ill patients of emergency department,so as to provide valuable information for TEG clinical application.Methods TEG and CCTs data of critically ill patients admitted from August 2015 to September 2016 in emergency department of Xijing Hospital were prospectively collected and retrospectively analyzed.The correlational analyses of analogue parameters of TEG and CCTs were carried out to investigate their clinical significance.ROC curve was used to explore the sensitivity and specificity of R for diagnosis of abnormal PT and APTT.Then comparisons of sensitivity of detecting abnormalities of clotting factors among R,PT and APTT were made.The changes of α and MA in patients with abnormal platelet count or fibrinogen concentration were respectively counted so as to evaluate the ability of oα and MA to reflect abnormal platelet count or fibrinogen concentration.The results of TEG and CCTs were comprehensively analyzed to find out the capability of TEG and CCTs in reflecting the overall blood coagulation status.The differece in blood transfusion rate was compared between TEG and CCTs in trauma patients.The chi-square test of matched fourfold table was used to test the significance and there was statistical significance when P ＜ 0.05.Results (1) R correlated weakly with PT and APTT,MA correlated moderately with FIB and PLT;K and α angle correlated moderately with PLT and weakly with FIB.For the TEG parameter,there was no correlation between R and MA.R correlated moderately with K,α,and K correlated strongly with α angle,MA,and α correlated strongly with MA.(2) For detecting PT ＞ 15.1 s,the sensitivity of R (＞ 10 min) was 32％ (95％ CI:0.20-0.47) and specificity was 90％ (95％CI:0.84-0.94).For detecting APTT ＞41.8 s,the sensitivity of R (＞ 10 min) was 39％ (95％ CI:0.25-0.54) and specificity was 91％ (95 ％ CI:0.85-0.95).(3) There was a low sensitivity for MA and α to detect PLT count or FIB concentration abnormality.(4) TEG was able to detect a few abnormal blood coagulation which CCTs could not detect.(5) TEG-guided transfusion reduced plasma transfusion ratein trauma patients.Conclusions There is a moderate or even weak correlation between TEG and CCTs parameters,R has a low sensitivity to detect abnormal blood coagulation factor than PT,APTT.TEG is mainly able to reflect functional abnormality of PLT and FIB rather than to reflect their quantitative changes.TEG is able to detect a few abnormal blood coagulation which CCTs are not able to detect.The use of TEG can reduces plasma transfusion rate in trauma patients.TEG has certain advantages over CCTs but is not able to completely replace CCTs.Individual component change and overall blood coagulation status can be assessed in their combination,suggesting more helpful for clinical diagnosis and treatment.

Value of thrombelastography in monitoring coagulation state of trauma patients with lower limb venous thrombosis / 中华创伤杂志

Objective To investigate the efficacy of thrombelastography (TEG) in monitoring the coagulation state of trauma patients with lower limb venous thrombosis.Methods A total of 64 trauma patients surgically treated from March 2015 to April 2015 were analyzed by retrospective case-control study.There were 32 males and 32 females,with an age range of 17-79 years (mean,53.44 years).None had significant vascular damage.The average time between injury and surgery was 8.8 days (range,2-20 days).The patients were divided into lower limb venous thrombosis group (thrombosis group,n =10) and non-venous-thrombosis group (non-thrombosis group,n =54) according to the diagnosis of color Doppler ultrasound.The causes of trauma included tumbling in 33 cases,fall from height in 8,traffic accident in 15,and compression injury in 8.The data were reviewed including variables of TEG [reaction time (R value),clot formation time (K value),α angle,maximum amplitude (MA)],platelet (PLT) count and variables of conventional coagulation tests (CCTs) [plasma prothrombin time (PT),activated partial thromboplastin time (APTT),and international normalized ratio (INR)].The correlation between R,K and CCTs and the correlation between α angle,MA and PLT were investigated.The variations of the two methods between two groups were investigated by receiver operating characteristic curve (ROC).Area under the curve (AUC),sensitivity and specificity of R value,K value,PT and APTT were analyzed.Results R value of thrombosis group was lower than that in non-thrombosis group [5.55 (4.78,5.85) min vs.6.20 (5.30,7.03) min] (P ＜ 0.05).There was no significant difference between the two groups in aspects of K value,o angle,MA,PT,APTT,INR,and PLT (P ＞ 0.05).The R value was positively correlated PT (r =0.65,P ＜ 0.05) and INR (r =0.69,P ＜ 0.05),but had no significant correlation with APTT or PLT count.The K value was not significantly correlated with PT,APTT,INR or PLT count,and PLT was not significantly correlated with α angle or MA.AUC was 0.73 in R value,0.66 in K value,0.58 in PT,and 0.60 in APIT.The sensitivity values to detect lower limb venous thrombosis in trauma patients were 87.04％ in R value (＜5 min),79.63％ in K value (＜1.00 min),0.00％ in PT (＜11.4 s),and 90.74 in APTT (＜27.4 s).The specificity values were 40.00％ in R value (＜5 min),40.00％ in K value (＜ 1.00 min),100.00％ in PT (＜ 11.4 s),and 20.00％ in APTT (＜ 27.4 s).Conclusion TEG is considered to be much more sensitive than CCTs for monitoring the coagulation state,and can be selected as the supplementary screening test for trauma patients with lower limb venous thrombosis.