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[Effects of induced hypotensive anesthesia on the blood coagulation-fibrinolysis system measured by thrombelastography--comparison between prostaglandin E1 and trimethaphan].

The coagulation-fibrinolysis system has been studied in two groups of 16 patients classified ASA 1 undergoing radical mastectomy during controlled hypotensive anesthesia induced by prostaglandin E1 (PGE1) or by trimethaphan (TMP) under enflurane anesthesia. Thrombelastography (TEG) was used to evaluate both coagulation and fibrinolysis systems, while simultaneously measuring platelet aggregation in response to ADP and collagen, prothrombin time (PT), activated partial thromboplastin time (APTT), serum concentrations of fibrinogen, and platelet counts. In the PGE1 group, APTT was significantly shortened (P less than 0.05) while the drug was being infused, but there was no statistically significant difference between the two groups, which was considered due to the effect of enflurane. Also, no statistically significant changes were noted in the other measured parameters. These results suggest that controlled hypotensive anesthesia using either PGE1 or TMP under enflurane anesthesia produces no significant changes in the blood coagulation-fibrinolysis system and that both are useful for the management of bleeding during surgery. Further, TEG was found to reflect other parameters properly. It is therefore useful for monitoring the blood coagulation-fibrinolysis system during anesthesia.

Adult↗

Thrombelastography as an aid to regional anesthesia: preliminary communication.

Thrombelastography (TEG), a less commonly available technique used to assess hemostatic function, has recently gained popularity. Analysis of TEG yields qualitative information about platelet function, thromboplastin generation and their interaction with the intrinsic cascade to form a stable clot. Additional information is obtained about fibrinogen and Factor XIII levels as well as the fibrinolytic system. TEG has been shown to be more sensitive and accurate than traditional coagulation tests at both predicting and treating coagulopathies. We report here three cases in which TEG was used to assess hemostatic function in patients at risk for bleeding prior to the induction of regional anesthesia. In all three cases, traditional tests were inadequate to predict the safe practice of regional anesthesia. TEG provided this information and regional anesthesia was successfully employed.

Aged↗

Thrombelastography during and after elective abdominal surgery.

Thrombelastography has been performed on recalcified whole blood from 50 patients before, during and after elective abdominal surgery. The characteristic changes of the thrombelastographic indices r, k and mA are described. During operation r and k shortened, but no change in mA was observed. This response was in part associated with an increase in factor VIII activity. Following operation, while r time was somewhat shortened, much more marked changes in k and mA were evident. Increasing fibrinogen concentration was the dominant factor in determining the post-operative changes in the thrombelastograph.

Abdomen↗

Characterization of a new potent heparin. 3rd Communication: Determinations of anticoagulant activity of a new potent heparin preparation by thrombelastography in vitro using citrated dog and human blood.

The anticoagulant effect of a new potent heparin preparation was compared with a commercially available heparin by thrombelastography in vitro using citrated dog and human blood. The relative potency of the new heparin was found to be 1.45 to 1.77 with dog citrated blood and 1.77 to 2.41 with human citrated blood on the basis of different thrombelastographic parameters.

Animals↗

Comparison of thrombelastography with common coagulation tests.

Thrombelastography, although proven as a useful research tool has not been evaluated for its clinical utility against common coagulation laboratory tests. In this study we compare the thrombelastographic measurements with six common tests (the hematocrit, platelet count, fibrinogen, prothrombin time, activated thromboplastin time and fibrin split products). For such comparisons, two samples of subjects were selected, 141 normal volunteers and 121 patients with cancer. The data was subjected to various statistical techniques such as correlation, ANOVA, canonical and discriminant analysis to measure the extent of the correlations between the two sets of variables and their relative strength to detect blood clotting abnormalities. The results indicate that, although there is a strong relationship between the thrombelastographic variables and these common laboratory tests, the thrombelastographic variables contain additional information on the hemostatic process.

Blood Coagulation Disorders↗

[Blood coagulation-fibrinolysis system during transurethral resection evaluated by thrombelastography].

Intraoperative changes in blood coagulation-fibrinolysis system were evaluated in 21 patients under epidural anesthesia by thrombelastography. Ten patients received transurethral resection of prostate (TUR-P) and 11 patients received transurethral resection of bladder tumor (TUR-Bt). Thrombelastographic variables: reaction time (R), coagulation time (K), maximum amplitude (MA), and amplitude 60 min after MA (A 60) were measured. The coagulability was evaluated by R + K, the absolute strength of clot by MA, and fibrinolysis using MA-A60. There was no significant change of these indices in TUR-Bt group. On the other hand, in TUR-P group, R + K was significantly shortened and MA-A60 had a tendency to increase it, but MA caused no change. Resected prostatic weight correlated significantly with the decrease of MA, and had a tendency to correlate with the increase of MA-A60 in TUR-P group. Both coagulation and fibrinolysis were activated in TUR-P group. When the resected prostatic weight is large, the risk of coagulopathy may increase.

Anesthesia, Epidural↗

Abruptio placentae and disseminated intravascular coagulation: use of thrombelastography and sonoclot analysis.

We report a case in which thrombelastography (TEG) and Sonoclot analysis were used for diagnosis and treatment decisions in a patient with abruptio placentae and disseminated intravascular coagulation. In addition to providing enough information for evaluation and treatment of this patient, the TEG and Sonoclot results were obtained more quickly, with smaller blood samples and with less expense to the patient in comparison to the standard coagulation tests in our institution. Although the TEG and Sonoclot results were assessed independently of the other test and each provided similar information in this case, the TEG may be the preferred tool in evaluating coagulopathies, based on computerization and strong literature support.

Journal Article↗

Vascular surgical society of great britain and ireland: thrombelastography can differentiate ischaemic from haemorrhagic stroke

BACKGROUND: Thrombolysis could be a major step forward in the treatment of acute ischaemic stroke. Early treatment is essential to maximize therapeutic benefit. Imaging by computed tomography (CT) or magnetic resonance imaging is mandatory to exclude haemorrhagic stroke before initiation of therapy. Thrombelastography (TEG), a test of global haemostasis, produces a characteristic tracing over 15-30 min. The potential of TEG to differentiate patients with ischaemic from haemorrhagic stroke was investigated. METHODS: Fifteen patients with a clinical diagnosis of acute stroke were studied. Fibrinogen levels and lipid profiles were measured, and CT of the brain, coagulation screens and TEG were performed. The CT scans were interpreted by a single radiologist. TEG data were classified as normal (index less than 2), hypercoagulable (index 2-3) or profoundly hypercoagulable (index greater than 3). RESULTS: There was no correlation between any of the parameters studied other than TEG with CT findings. Both patients with a haemorrhagic stroke showed normal findings on TEG. Eleven of the 12 patients with ischaemic stroke were hypercoagulable or profoundly hypercoagulable. CONCLUSION: TEG is capable of differentiating haemorrhagic from ischaemic stroke. It has the potential to target thrombolytic therapy for those patients most likely to benefit.

Journal Article↗