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TEG AS A GUIDE TO TREATMENT THROMBOELASTOGRAPHY-GUIDED TRANSFUSION PARAMETERS r-TEG parameter Normal range Transfusion trigger TEG-ACT 78-110 seconds >120 seconds (FFP) Alpha angle 66°-82° <66° (cryoprecipitate) K value 30-120 seconds >120 seconds (cryoprecipitate) MA (maximum amplitude) 54-72 mm <54 mm (platelets) G value 5.3-12.4 dynes/ second <5.3 dynes/second* LY-30 (lysis at 30 min) 0-8 percent >8 percent​¶ Stahel PF, Moore EE, Schreier SL, et al. Transfusion strategies in postinjury coagulopathy. Curr Opin Anaesthesiol 2009; 22:289 Despite the potential for expanded use, the use of TEG in the Neuro- ICU is limited and remains largely investigational. TEG may provide valuable information in traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and acute ischemic stroke (AIS). Trials examining the role of TEG in ICH, demonstrated a potential role in predicting hematoma expansion. With subarachnoid hemorrhage, TEG may help identify patients who are hypercoagulable (with significant increase in MA) or prone to aneurysm re-rupture. There maybe a role in prognostication following TBI or providing a therapeutic target in the mitigation of contusion expansion. In acute ischemic strokes, TEG may be useful in future studies to determine patients who will be aspirin non responders, orprone to thrombolytic resistance or complications. Despite having been developed in 1948, data regarding its application in the Neuro-ICU remains preliminary. Ranges of normal values and therapeutic strategies have not yet been elucidated. TEG has the potential to revolutionize the management of thrombosis and hemostasis in Neurocritical care, however further information is necessary to determine the role that TEG will ultimately have in the clinical care of NCC patients. REFERENCES: N. Kreitzer & C.Zammit Review of Thromboelastography in Neurocritical Care Neurocrit Care (2015) 23:427–433 Stahel PF, Moore EE, Schreier SL, et al. Transfusion strategies in postinjury coagulopathy. Curr Opin Anaesthesiol 2009; 22:289 Bollinger D, Seeberger M, Tanaka K. Principles and Practice of Thromboelastography in Clinical Coagulation Management and Transfusion Practice. Transfusion Medicine Re-views, Vol 26, No 1 (January), 2012: pp 1-13 Brinkman H. Global assays and the management of oral antico-agulation. Thrombosis Journal (2015) 13:9 http://lifeinthefastlane.com/ccc/thromboelastogram-teg/ http://www.surgicalcriticalcare.net/Guidelines/TEG%202014.pdf 28


eMag_264548_NCS Currents_December2016_3
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