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4.4 - Monitoring Coagulation, Including Thromboelastography

from Section 4 - Therapeutic Interventions and Organ Support

Published online by Cambridge University Press:  27 July 2023

Ned Gilbert-Kawai
Affiliation:
The Royal Liverpool Hospital
Debashish Dutta
Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann
Affiliation:
Royal Berkshire Hospital, Reading
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Summary

Key Learning Points

  1. 1. Coagulopathy is common in the ICU and abnormal results should be interpreted in the context of the patient’s clinical condition.

  2. 2. Conventional coagulation tests monitor the intrinsic and extrinsic pathways of coagulation and are the mainstay of haemostatic monitoring.

  3. 3. Full blood count and conventional coagulation tests have a turnaround time that renders them unhelpful in acute bleeding scenarios.

  4. 4. Point-of-care viscoelastic tests, such as thromboelastography (TEG®) and rotational thromboelastrometry (ROTEM®), can provide a rapid overview of coagulation from clot formation to lysis, demonstrating both hypo- and pro-coagulant states.

  5. 5. Algorithms based upon viscoelastic tests in bleeding patients have demonstrated a reduction in blood transfusion requirements.

Type
Chapter
Information
Intensive Care Medicine
The Essential Guide
, pp. 473 - 476
Publisher: Cambridge University Press
Print publication year: 2021

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References

References and Further Reading

Haas, T, Fries, D, Tanaka, KA, et al. Usefulness of standard plasma coagulation tests in the management of perioperative coagulopathic bleeding: is there any evidence? Br J Anaesth 2015;114:217–24.Google Scholar
Kozek-Langenecker, SA, Ahmed, AB, Afshari, A, et al. Management of severe perioperative bleeding. Eur J Anaesthesiol 2017;34:332–95.CrossRefGoogle ScholarPubMed
Lancé, MD. A general review of major global coagulation assays: thromboelastography, thrombin generation test and clot waveform analysis. Thromb J 2015;13:2607.CrossRefGoogle ScholarPubMed
Levi, M, Hunt, BJ. A critical appraisal of point-of-care coagulation testing in critically ill patients. J Thromb Haemost 2015;13:1960–7.CrossRefGoogle ScholarPubMed
Mallett, SV, Armstrong, M. Point-of-care monitoring of haemostasis. Anaesthesia 2014;70(Suppl 4):73–7, e25–6.Google Scholar

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