Abstract
Thromboelastography (TEG) has been used for decades to guide transfusion therapy during cardiac and hepatic surgeries. Renewed interest and improved technology have led to wider applications of TEG in other areas of hemostasis. To correctly interpret the data generated and to validate outcomes, it is important to improve the understanding of the differences in the currently available assay procedures, the issues related to sample activation, and the importance of the use of appropriate controls. Current TEG assays use a variety of samples and can vary slightly in the procedures. In this chapter, we very briefly review TEG applications and discuss interpretations, normal ranges, and reference controls, and we explain the method of TEG run using standard citrated native blood samples. We provide detailed technical steps and tips. We discuss precautions and issues related to the assay, which we hope can guide toward better application and data interpretation.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Hartert H (1948) Blutgerinnungsstudien mit der Thrombelastographie, einem neuen Untersuchungsverfahren. Klin Wochenschr 26:577–583
Da Luz LT, Nascimento B, Shankarakutty AK, Rizoli S, Adhikari NK (2014) Effect of thromboelastography (TEG(R)) and rotational thromboelastometry (ROTEM(R)) on diagnosis of coagulopathy, transfusion guidance and mortality in trauma: descriptive systematic review. Crit Care 18:518
Young G, Sorensen B, Dargaud Y, Negrier C, Brummel-Ziedins K, Key NS (2013) Thrombin generation and whole blood viscoelastic assays in the management of hemophilia: current state of art and future perspectives. Blood 121:1944–1950
Rafiq S, Johansson PI, Zacho M, Stissing T, Kofoed K et al (2012) Thrombelastographic haemostatic status and antiplatelet therapy after coronary artery bypass surgery (TEG-CABG trial): assessing and monitoring the antithrombotic effect of clopidogrel and aspirin versus aspirin alone in hypercoagulable patients: study protocol for a randomized controlled trial. Trials 13:48
Muller MC, Meijers JC, Vroom MB, Juffermans NP (2014) Utility of thromboelastography and/or thromboelastometry in adults with sepsis: a systematic review. Crit Care 18:R30
Shreeve NE, Barry JA, Deutsch LR, Gomez K, Kadir RA (2016) Changes in thromboelastography parameters in pregnancy, labor, and the immediate postpartum period. Int J Gynaecol Obstet 134:290–293
Solomon C, Collis RE, Collins PW (2012) Haemostatic monitoring during postpartum haemorrhage and implications for management. Br J Anaesth 109:851–863
Sewell EK, Forman KR, Wong EC, Gallagher M, Luban NL, Massaro AN (2016) Thromboelastography in term neonates: an alternative approach to evaluating coagulopathy. Arch Dis Child Fetal Meonatal Ed 102(1):F79–F84
Wiinberg B, Kristensen AT (2010) Thromboelastography in veterinary medicine. Semin Thromb Hemost 36:747–756
Dias JD, Norem K, Doorneweerd DD, Thurer RL, Popovsky MA, Omert LA (2015) Use of thromboelastography (TEG) for detection of new oral anticoagulants. Arch Pathol Lab Med 139:665–673
Nielsen VG (2007) A comparison of the Thrombelastograph and the ROTEM. Blood Coagul Fibrinolysis 18:247–252
Hett DA, Walker D, Pilkington SN, Smith DC (1995) Sonoclot analysis. Br J Anaesth 75:771–776
Chitlur M, Rivard GE, Lillicrap D, Mann K, Shima M et al (2014) Recommendations for performing thromboelastography/thromboelastometry in hemophilia: communication from the SSC of the ISTH. J Thromb Haemost 12:103–106
Solomon C, Asmis LM, Spahn DR (2016) Is viscoelastic coagulation monitoring with ROTEM or TEG validated? Scand J Clin Lab Invest 76:503–507
MacDonald SG, Luddington RJ (2010) Critical factors contributing to the thromboelastography trace. Semin Thromb Hemost 36:712–722
Young G, Zhang R, Miller R, Yassin D, Nugent DJ (2010) Comparison of kaolin and tissue factor activated thromboelastography in haemophilia. Haemophilia 16:518–524
Banerjee A, Blois SL, Wood RD (2011) Comparing citrated native, kaolin-activated, and tissue factor-activated samples and determining intraindividual variability for feline thromboelastography. J Vet Diagn Invest 23:1109–1113
Durila M, Lukas P, Bronsky J, Cvachovec K (2015) Time impact on non-activated and kaolin-activated blood samples in thromboelastography. BMC Anesthesiol 15:50
Livnat T, Shenkman B, Martinowitz U, Zivelin A, Dardik R et al (2015) The impact of thrombin generation and rotation thromboelastometry on assessment of severity of factor XI deficiency. Thromb Res 136:465–473
Cvirn G, Tafeit E, Hoerl G, Janschitz M, Wagner T et al (2010) Heparinase-modified thrombelastometry: inactivation of heparin in plasma samples. Clin Lab 56:585–589
Scarpelini S, Rhind SG, Nascimento B, Tien H, Shek PN et al (2009) Normal range values for thromboelastography in healthy adult volunteers. Braz J Med Biol Res 42:1210–1217
de Lange NM, van Rheenen-Flach LE, Lance MD, Mooyman L, Woiski M et al (2014) Peri-partum reference ranges for ROTEM(R) thromboelastometry. Br J Anaesth 112:852–859
Kasawara KT, Cotechini T, Macdonald-Goodfellow SK, Surita FG, Pinto ESJL et al (2016) Moderate exercise attenuates lipopolysaccharide-induced inflammation and associated maternal and fetal morbidities in pregnant rats. PLoS One 11:e0154405
Kaur H, Corscadden K, Lott C, Elbatarny HS, Othman M (2016) Bromelain has paradoxical effects on blood coagulability: a study using thromboelastography. Blood Coagul Fibrinolysis 27:745–752
Toukh M, Pereira EJ, Falcon BJ, Liak C, Lerner M et al (2012) CPAP reduces hypercoagulability, as assessed by thromboelastography, in severe obstructive sleep apnoea. Respir Physiol Neurobiol 183:218–223
Cotechini T, Othman M, Graham CH (2012) Nitroglycerin prevents coagulopathies and foetal death associated with abnormal maternal inflammation in rats. Thromb Haemost 107:864–874
Falcon BJ, Cotechini T, Macdonald-Goodfellow SK, Othman M, Graham CH (2012) Abnormal inflammation leads to maternal coagulopathies associated with placental haemostatic alterations in a rat model of foetal loss. Thromb Haemost 107:438–447
Toukh M, Siemens DR, Black A, Robb S, Leveridge M et al (2014) Thromboelastography identifies hypercoagulablilty and predicts thromboembolic complications in patients with prostate cancer. Thromb Res 133:88–95
Toukh M, Ozelo MC, Angelillo-Scherrer A, Othman MA (2013) Novel use of thromboelastography in type 2B von Willebrand disease. Int J Lab Hematol 35(6):e11–e14
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer Science+Business Media LLC
About this protocol
Cite this protocol
Othman, M., Kaur, H. (2017). Thromboelastography (TEG). In: Favaloro, E., Lippi, G. (eds) Hemostasis and Thrombosis. Methods in Molecular Biology, vol 1646. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-7196-1_39
Download citation
DOI: https://doi.org/10.1007/978-1-4939-7196-1_39
Published:
Publisher Name: Humana Press, New York, NY
Print ISBN: 978-1-4939-7194-7
Online ISBN: 978-1-4939-7196-1
eBook Packages: Springer Protocols