Thromboelastography (TEG) [Neurosurgery Wiki]

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====== Thromboelastography (TEG) ======

{{ ::thromboelastography.jpg?400|}}

Thromboelastography, is a method of testing the efficiency of blood [[coagulation]]. It is a test mainly utilized in surgery and anesthesiology, although few centers are capable of performing it. More common tests of [[blood]] [[coagulation]] include [[prothrombin time]] (PT,INR) and [[partial thromboplastin time]] (aPTT) which measure coagulation factor function, but TEG also can assess platelet function, clot strength, and [[fibrinolysis]] which these other tests cannot.

TEG may be a clinically sensitive test for identifying the underlying [[coagulopathy]] following [[TBI]]. However, confirmation with conventional coagulation tests (CCTs) is recommended
((Albert V, Subramanian A, Pati HP, Agrawal D, Bhoi SK. Efficacy of
Thromboelastography (TEG) in Predicting Acute Trauma-Induced Coagulopathy (ATIC) 
in Isolated Severe Traumatic Brain Injury (iSTBI). Indian J Hematol Blood
Transfus. 2019 Apr;35(2):325-331. doi: 10.1007/s12288-018-1003-4. Epub 2018 Aug
11. PubMed PMID: 30988571; PubMed Central PMCID: PMC6439129.
)).
----
[[Platelet]] function testing with TEG altered a [[dual antiplatelet therapy]] (DAT) induction strategy in a significant number of cases. 

Future studies should compare methods of platelet function testing and, possibly, no platelet function testing in neurovascular patients undergoing [[flow diversion]] and/or stent-assisted treatment of intracranial aneurysms
((McTaggart RA, Choudhri OA, Marcellus ML, Brennan T, Steinberg GK, Dodd RL, Do 
HM, Marks MP. Use of thromboelastography to tailor dual-antiplatelet therapy in
patients undergoing treatment of intracranial aneurysms with the Pipeline
embolization device. J Neurointerv Surg. 2015 Jun;7(6):425-30. doi:
10.1136/neurintsurg-2013-011089. Epub 2014 Apr 16. PubMed PMID: 24739599.
)).
----
Fulkerson et al. describe a 12-year-old [[female]] who experienced a number of [[complication]]s after a [[craniopharyngioma surgery]]. The patient suffered multiple new [[intraventricular hemorrhage]]s with removal of [[external ventricular drain]]s. Standard [[coagulopathy]] tests did not reveal any abnormalities. However, an abnormal [[thromboelastography]] (TEG) value suggested primary [[hyperfibrinolysis]], which led to a change in medical [[management]]. The patient did not suffer any further bleeding episodes after the change in treatment.

The authors discuss a case where TEG influenced patient management and identified a problem despite normal values of standard [[laboratory]] tests. Neurosurgeons should be aware of the potential benefits for TEG testing in [[pediatric patient]]s
((Fulkerson DH, Weyhenmeyer J, Archer JB, Shaikh KA, Walsh M.
Thromboelastography-Guided Therapy of Hemorrhagic Complications after
Craniopharyngioma Resection: Case-Based Update. Pediatr Neurosurg. 2019 Aug
7:1-8. doi: 10.1159/000501117. [Epub ahead of print] Review. PubMed PMID:
31390646.
)).

===== Thromboelastography-Guided Anticoagulant Therapy =====
[[Thromboelastography-Guided Anticoagulant Therapy]]

===== References =====