A Review of Thromboelastography

The ability of blood to coagulate protects the body from life-threatening exsanguinations. This process is determined by a complex and balance between pro-coagulation factors, anticoagulants, and fibrinolysis. Major bleeding is a serious medical complication and an accurate and cost-efficient method of monitoring antithrombotic activity would be extremely useful. The commonly used blood tests to assess blood coagulation include prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), platelet count, fibrinogen concentration, D-dimer level, activated clotting time, and whole blood bleeding time (BT). However, there are delays in obtaining the results, especially when there is acute major bleed. These tests do not provide a complete picture of haemostasis like factor XIII, platelet function and the activity of the fibrinolytic system. While platelet count is part of a complete blood count, it does not reflect their function. TEG provides a representation of the sum of platelet function, coagulation proteases and inhibitors, and the fibrinolytic system. Analysis of the tracing provides a means to assess the need for blood component therapy as each element of the TEG tracing relates to a different aspect of clotting. TEG helps anesthesiologists monitor intraoperative bleeding and choose the most adequate blood transfusion products to achieve an optimal biological hemostasis. TEG provides a rapid point-of-care assessment of the coagulation process, with initial results available within 5 minutes. TEG is a promising diagnostic modality that offers several advantages compared to the other tests that have been mentioned above. TEG covers the entire field of hemostasis in the perioperative setting, from platelet function to fibrinolysis and also to monitor hypercoagulability. It has become so popular that many clinicians consider thromboelastography a self-sufficient coagulation test