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The thromboelastogram (TEG) measures functional defects in coagulation, from fibrin formation through platelet aggregation to fibrinolysis. It is comparable with standard laboratory tests of coagulation; however, it provides additional useful qualitative information. This prospective study documents the TEG findings in 103 neonates: 60 were normal and healthy and provided a reference range; 12 surgical babies had established sepsis, 15 had early sepsis, and 16 were non-septic. TEG abnormalities were detected only in those patients with early and established sepsis. Abnormalities were found in all but 1 of this group of 27 patients (96%), whereas only 16 (59%) had thrombocytopenia, 2 (6%) had leukocytosis, and 6 had leukopenia. The TEG had a sensitivity for sepsis of 96% and a specificity of 96%. This exceeds the values for routine full blood-count parameters and other laboratory indicators of sepsis. It was found to be a simple, quick, and sensitive indicator of early sepsis that enabled the clinicians to manage septic newborns earlier.
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PURPOSE: To investigate perioperative coagulation in morbidly obese (MO) patients with the thromboelastograph (TEG) and Sonoclot analyzer. METHODS: Twenty-six consecutive morbidly obese and 26 consecutive lean patients presenting for elective surgery were enrolled in this prospective, observational study. Blood was sampled for TEG and Sonoclot analysis immediately after anaesthetic induction and at the end of surgery in the MO group, and immediately after anaesthetic induction in the lean group. The R and K times, alpha angle, maximum amplitude and percentage fibrinolysis at 30 and 60 min were recorded from the TEG. The Sonoclot ACT, initial clot rate, peak amplitude and time to peak amplitude were recorded from the Sonoclot. RESULTS: The TEG in the MO group demonstrated decreased R and K times (8.6 +/- 4.8 vs 11.7 +/- 3.9 mm, and 2.8 +/- 1.2 vs 3.5 +/- 0.9 mm respectively (P < 0.05)), and increased alpha angle (73.7 +/- 6.0 vs 66.7 +/- 6.0 degrees, P < 0.05) and maximum amplitude (72.0 +/- 5.4 vs 67.9 +/- 4.4 mm, P < 0.05), without change in fibrinolysis. Sonoclot variables in the MO group included increased clot rate (37.5 +/- 11.5 vs 23.9 +/- 7.7%, P < 0.05) and decreased time to peak impedance (11.7 +/- 5.0 vs 17.5 +/- 7.2 min, P < 0.05), without change in Sonoclot ACT or peak signature impedance. CONCLUSION: The MO group demonstrated accelerated fibrin formation, fibrinogen-platelet interaction, and platelet function compared with lean controls but no difference in fibrinolysis. Viscoelastic measures of coagulation may be useful in MO patients, who are at increased risk of thromboembolic events.
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Patients with cancer have an increased incidence of thrombosis and abnormal haemostasis detectable by sophisticated laboratory tests. Whether abnormalities in such highly sensitive assays is clinically relevant to bleeding or thrombosis is not clear. The thromboelastograph (TEG) and Sonoclot analyzers assess the coagulation process in whole blood and may therefore be physiologically more relevant than assays of isolated haemostatic components. Blood was collected from healthy volunteers and patients with breast cancer, colorectal cancer or benign disease and tested in the TEG and Sonoclot. Results in the cancer group were compared to appropriately sex-matched controls. The TEG parameters R (P < 0.02), angle (P < 0.05) and MA (P < 0.001) were abnormal in colorectal cancer; up to 8/17 (47%) patients being assessed as hypercoagulable. R (P < 0.05), angle (P = 0.05) and MA (P < 0.001) were abnormal in breast cancer; 2/21 (9%) patients having abnormal results. In the Sonoclot Analyzer, 11/17 (64%) patients with colorectal cancer had a significant increase in clot rate (P < 0.001) while 2/17 had a decreased SonACT time (P = 0.05). 4/21 (19%) breast cancer patients had a significant increase in clot rate (P < 0.001) and the SonACT was shortened (P = 0.05). Platelets and fibrinogen levels were generally normal and only one patient had clinical evidence of thrombosis. There were no significant coagulation changes in patients with benign colon or breast disease. In conclusion, hypercoagulability was detected in a high proportion of breast and colorectal cancer patients by both techniques. The clot rates of the TEG and Sonoclot were significantly correlated but the latter was abnormal in a greater proportion of cancer patients.
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In the absence of a direct laboratory test of envenomation, there is a need for an alternative mechanism for the early recognition of envenomation following snake-bite in children. A severe clinical diathesis may result either from envenomation or from the release of an inappropriate tourniquet applied as 'first-aid' often several hours before presentation to hospital. Abnormalities of clotting are associated with both events. A normal thromboelastogram (TEG) provides early recognition of patients in whom the clinical course is likely to be benign (sensitivity = 94%). An abnormal TEG identifies patients of whom 50% will develop a severe clinical diathesis. A TEG is a more accurate predictor of disease severity than International Normalized Ratio alone. The TEG does not supplant clinical observation in the management of snake-bite in children but allows stratification into high- and low-risk categories.
BACKGROUND: Thrombelastography is a useful technique for evaluating coagulability. We hypothesized that it could be used to determine postoperative hematologic complications during and after neurologic surgery. METHODS: Forty-six neurosurgical patients were stratified by diagnosis: subarachnoid hemorrhage from ruptured intracranially aneurysms, intracranial-axial lesions, intracranial-extra-axial lesions, and degenerative spine disease. Thromboelastograms were performed before, during, and after surgery. Hematologic data were collected preoperatively and postoperatively; computed tomography scans and lower extremity Doppler sonography were performed postoperatively. A thrombosis index (TI) was used to assess coagulability. RESULTS: Coagulability increased over the course of surgery for all patients (p < 0.0001). In craniotomy patients, coagulability increased over the course of surgery (p < 0.05) with the most dramatic increase from intubation to skin incision (p < 0.05), and then after tumor removal or aneurysm clipping (p < 0.10). Univariate analysis among craniotomy patients showed that female gender (p < 0.0004) and smoking (p < 0.06) were associated with hypercoagulability. Among craniotomy patients, younger age was associated with hypercoagulability in the preoperative period (p < 0.01). There was no significant association between coagulability and aspirin or NSAID use, or intraoperative fluid volume. No patient developed a postoperative hematoma and one patient (2.2%) developed a lower extremity deep vein thrombosis. CONCLUSIONS: Increased coagulability begins between induction of anesthesia and skin incision, and continues to increase throughout surgery. These changes are more pronounced in patients undergoing craniotomy compared to patients undergoing spine procedures.