A Literature Review of TEG and the Evaluation of Dilutional Coagulopathy
Eric Eisenman, MD and A. Wendling, MD
Department of Anesthesiology, University of Florida, Gainesville, Florida
Thromboelastography (TEG) is commonly used in the operating room to
evaluate coagulopathy. Thromboelastography is a measure of global hemostasis,
and is routinely used during cardiac and hepatic surgery. The basic
principles of operation and TEG pattern characteristics will be examined.
The clinical relevance of reaction time (R), clot formation time (K), alpha
angle, maximum amplitude (MA), and time to complete clot lysis (F) will be
discussed.
An example of the use of TEG to evaluate a case of coagulopathy after
massive transfusion in an elective surgery will be presented. In order to
further elucidate the use of TEG in general surgery, a literature review of
the data regarding the evaluation of dilutional coagulopathy with TEG as
compared to traditional laboratory tests (prothrombin time, activated
partial thromboblastin time, activated coagulation time) will be further
explored. Although there are several studies addressing the use of TEG in
cardiac and hepatic surgery, an analysis of the current literature regarding
the use of TEG in the evaluation of dilutional coagulopathy exemplifies its
utility not only in cardiac and hepatic surgery but also in trauma, ICU, and
general surgery to optimize blood product usage and decrease the morbidity
and mortality associated with coagulopathy and massive transfusion.
By reviewing the mechanics of the thromboelastogram and reviewing the
literature regarding dilutional coagulopathy, it is hoped that better
management of coagulopathy will result in a decrease of donor exposure and
the risks accompanying transfusion of heterogeneous blood products.
