TEG 6s thrombelastography versus conventional coagulation assays in infants and toddlers during craniosynostosis surgery: a prospective observational clinical study

Craniosynostosis surgery is associated with severe diffuse bleeding, which can result in a significant coagulopathy. The aim of this study was to compare Thrombelastograph Coagulation Analyzer TEG 6s parameters and the time required for result availability with conventional coagulation parameters (CCP) during pediatric craniosynostosis surgery. In this prospective clinical observational study, 29 infants and toddlers (median age 6 months, median weight 8.5 kg) undergoing craniosynostosis surgery were enrolled. Blood was sampled preoperatively and perioperatively. Samples were analyzed by TEG 6s and CCP [prothrombin time (PT) (for analysis of quick time/INR), aPTT, fibrinogen, factor XIII, and antithrombin III]. The TEG 6s parameters (reaction time 'R', coagulation time 'K', maximum amplitude 'MA') and CCP were related using linear regression analyses. The required turnaround times for both methods (TEG 6s and CCP) were recorded as medians and interquartile ranges [IQR]. Highest R2 values were obtained for the CK-R-aPTT relationship (R2 = 0.448), for the CK-MA-fibrinogen relationship (R2 = 0.47) and for the CK-K-aPTT relationship (R2 = 0.631). Initial availability was after 30 [9.1-14.1] min for CCP and after 16.1 min [9.1-14.1] for TEG 6s. Linear relationships between TEG 6s and CCP are rather low. This is best explained by the fact that TEG 6s and CCP do not measure identical coagulatory substrates and dynamics. However, regarding the TEG 6s-related time advantage compared to CCP and the possibility to monitor coagulation dynamics including fibrinolysis the TEG 6s is well-suited to guiding coagulation management in children undergoing craniosynostosis surgery.