Key result
Thromboelastography effectively predicted mortality, coagulopathy, and blood product requirements in trauma, ICU, and cardiovascular surgeries across 210 reviewed studies, though its utility in obstetrics and orthopedics was less consistent.
Why the study?
Traditional coagulation tests provide only static evaluations and are not designed to assess dynamically changing coagulation during the perioperative period.
Does thromboelastography improve the prediction and management of coagulopathy, bleeding, and mortality in patients during the perioperative period?
Does thromboelastography improve the prediction and management of coagulopathy, bleeding, and mortality in patients during the perioperative period?
TEG is a valuable tool for dynamic coagulation assessment in the perioperative period, particularly for guiding transfusion and predicting mortality in trauma, though more standardized RCTs are needed.
TEG may guide management in trauma, ICU, and CV surgery; leaves open consistent utility in obstetrics and orthopedics.
Assessing coagulation status is essential for prompt intervention to reduce morbidity and mortality related to bleeding and thrombotic complications during the perioperative period. Traditional coagulation tests such as platelet count, activated partial thromboplastin time (aPTT), prothrombin time (PT), international normalized ratio (INR), and activated clotting time (ACT) provide only static evaluation. These tests are not designed for assessment of dynamically changing coagulation conditions during the perioperative time. However, viscoelastic coagulation testing such as thromboelastography (TEG) produces a rapid numerical and graphical representation that helps to detect and direct targeted hemostatic therapy. Searching the literature through PubMed, Medline, Ovid, CINAHL, and ClinicalTrials.gov we retrieved 210 studies, which represent the use of TEG in the perioperative period. The included studies were categorized under various settings such as trauma, obstetrics, orthopedics, intensive care unit (ICU), cardiovascular, transplant, and miscellaneous scenarios. TEG showed promising results in trauma surgeries in predicting mortality, hypercoagulability, and bleeding even when it was compared to conventional methods. TEG was also useful in monitoring anticoagulant therapy in orthopedic and obstetric surgeries; however, its role in predicting thrombotic events, hypercoagulability, or complications was questionable. In ICU patients, it showed promising results, especially in the prediction or improvement of sepsis, coagulopathy, thrombotic events, ICU duration, hospital stay, and ventilator duration. TEG parameters effectively predicted hypercoagulation in transplant surgeries. Regarding cardiovascular surgeries, they were effective in the prediction of the need for blood products, coagulopathy, thrombotic events, and monitoring anticoagulation therapy. More randomized clinical trials comparing TEG parameters with standardized tools are needed to produce robust results to standardize its use in different perioperative settings.
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Ramanujam et al. (2023) conducted a review in Perioperative coagulopathy and bleeding. Thromboelastography (TEG) vs. Conventional coagulation tests was evaluated on Clinical outcomes including mortality, blood product usage, coagulopathy, and thrombotic events. Thromboelastography effectively predicted mortality, coagulopathy, and blood product requirements in trauma, ICU, and cardiovascular surgeries across 210 reviewed studies, though its utility in obstetrics and orthopedics was less consistent.
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