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Coagulation testing in the perioperative period.

Thiruvenkatarajan V, Pruett A, Adhikary SD - Indian J Anaesth (2014)

Bottom Line: Perioperative coagulation management is a complex task that has a significant impact on the perioperative journey of patients.While the rapidly available bedside haemoglobin measurements can guide the transfusion of red blood cells, blood product administration is guided by many in vivo and in vitro tests.A proper understanding of the application and interpretation of the coagulation tests is vital for a good perioperative outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville, South Australia ; Discipline of Acute Care Medicine, The University of Adelaide, South Australia.

ABSTRACT
Perioperative coagulation management is a complex task that has a significant impact on the perioperative journey of patients. Anaesthesia providers play a critical role in the decision-making on transfusion and/or haemostatic therapy in the surgical setting. Various tests are available in identifying coagulation abnormalities in the perioperative period. While the rapidly available bedside haemoglobin measurements can guide the transfusion of red blood cells, blood product administration is guided by many in vivo and in vitro tests. The introduction of newer anticoagulant medications and the implementation of the modified in vivo coagulation cascade have given a new dimension to the field of perioperative transfusion medicine. A proper understanding of the application and interpretation of the coagulation tests is vital for a good perioperative outcome.

No MeSH data available.


Related in: MedlinePlus

Comparative tracing of a normal TEG® and ROTEM®. The bold line represents TEG® and corresponding ROTEM® tracing is represented by dotted line. R, reaction time; α angle, slope between R and K for TEG® and slope of the tangent at 2 mm amplitude for ROTEM®; MA, maximum amplitude; CL 30, clot lysis at 30 min; CL 60, clot lysis at 60 min; CT, clotting time; CFT, clot formation time; MCF, maximum clot firmness; LY30, lysis at 30 min; LY60, lysis at 60 min
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Figure 3: Comparative tracing of a normal TEG® and ROTEM®. The bold line represents TEG® and corresponding ROTEM® tracing is represented by dotted line. R, reaction time; α angle, slope between R and K for TEG® and slope of the tangent at 2 mm amplitude for ROTEM®; MA, maximum amplitude; CL 30, clot lysis at 30 min; CL 60, clot lysis at 60 min; CT, clotting time; CFT, clot formation time; MCF, maximum clot firmness; LY30, lysis at 30 min; LY60, lysis at 60 min

Mentions: The TEG® was developed by Hartert in 1948. The TEG® analyses and graphically displays the changes in viscoelasticity across all stages of clot formation and resolution. This is in contrast to many other coagulation tests where the time to first fibrin formation is used as an end point.[1] The TEG is a fibrinolysis sensitive assay that analyses the interaction between platelets, fibrinogen and clotting factors and aids in the diagnosis of hyperfibrinolysis in the context of bleeding.[21] The device uses a tiny 0.35 ml of blood loaded into two disposable heated cups (37°C) containing contact activators. A pin is suspended in the blood sample by a torsion wire attached to an electronic recorder, and the cup rotates through 4°45’ in each direction lasting 10 s[22] [Figure 2]. With the formation of the clot, the pin gets embroiled within the clot and the torque of the cup is transmitted across the pin and the torsion wire to a mechano-electrical transducer [Figures 2 and 3]. The generated electric signal gets converted into a cigar shaped graphical display demonstrating the characteristic of shear elasticity against time.[21] The shape of the graphical display aids in a quick qualitative assessment of different coagulation states (hypo, normal, hyper) representing specific abnormalities in clot formation and fibrinolysis.


Coagulation testing in the perioperative period.

Thiruvenkatarajan V, Pruett A, Adhikary SD - Indian J Anaesth (2014)

Comparative tracing of a normal TEG® and ROTEM®. The bold line represents TEG® and corresponding ROTEM® tracing is represented by dotted line. R, reaction time; α angle, slope between R and K for TEG® and slope of the tangent at 2 mm amplitude for ROTEM®; MA, maximum amplitude; CL 30, clot lysis at 30 min; CL 60, clot lysis at 60 min; CT, clotting time; CFT, clot formation time; MCF, maximum clot firmness; LY30, lysis at 30 min; LY60, lysis at 60 min
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4260302&req=5

Figure 3: Comparative tracing of a normal TEG® and ROTEM®. The bold line represents TEG® and corresponding ROTEM® tracing is represented by dotted line. R, reaction time; α angle, slope between R and K for TEG® and slope of the tangent at 2 mm amplitude for ROTEM®; MA, maximum amplitude; CL 30, clot lysis at 30 min; CL 60, clot lysis at 60 min; CT, clotting time; CFT, clot formation time; MCF, maximum clot firmness; LY30, lysis at 30 min; LY60, lysis at 60 min
Mentions: The TEG® was developed by Hartert in 1948. The TEG® analyses and graphically displays the changes in viscoelasticity across all stages of clot formation and resolution. This is in contrast to many other coagulation tests where the time to first fibrin formation is used as an end point.[1] The TEG is a fibrinolysis sensitive assay that analyses the interaction between platelets, fibrinogen and clotting factors and aids in the diagnosis of hyperfibrinolysis in the context of bleeding.[21] The device uses a tiny 0.35 ml of blood loaded into two disposable heated cups (37°C) containing contact activators. A pin is suspended in the blood sample by a torsion wire attached to an electronic recorder, and the cup rotates through 4°45’ in each direction lasting 10 s[22] [Figure 2]. With the formation of the clot, the pin gets embroiled within the clot and the torque of the cup is transmitted across the pin and the torsion wire to a mechano-electrical transducer [Figures 2 and 3]. The generated electric signal gets converted into a cigar shaped graphical display demonstrating the characteristic of shear elasticity against time.[21] The shape of the graphical display aids in a quick qualitative assessment of different coagulation states (hypo, normal, hyper) representing specific abnormalities in clot formation and fibrinolysis.

Bottom Line: Perioperative coagulation management is a complex task that has a significant impact on the perioperative journey of patients.While the rapidly available bedside haemoglobin measurements can guide the transfusion of red blood cells, blood product administration is guided by many in vivo and in vitro tests.A proper understanding of the application and interpretation of the coagulation tests is vital for a good perioperative outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville, South Australia ; Discipline of Acute Care Medicine, The University of Adelaide, South Australia.

ABSTRACT
Perioperative coagulation management is a complex task that has a significant impact on the perioperative journey of patients. Anaesthesia providers play a critical role in the decision-making on transfusion and/or haemostatic therapy in the surgical setting. Various tests are available in identifying coagulation abnormalities in the perioperative period. While the rapidly available bedside haemoglobin measurements can guide the transfusion of red blood cells, blood product administration is guided by many in vivo and in vitro tests. The introduction of newer anticoagulant medications and the implementation of the modified in vivo coagulation cascade have given a new dimension to the field of perioperative transfusion medicine. A proper understanding of the application and interpretation of the coagulation tests is vital for a good perioperative outcome.

No MeSH data available.


Related in: MedlinePlus