1.
The Use of Thromboelastography in Percutaneous Coronary Intervention and Acute Coronary Syndrome in East Asia: A Systematic Literature Review
Xu O, Hartmann J, Tang YD, Dias J
Journal of clinical medicine. 2022;11(13)
Abstract
Dual antiplatelet therapy (DAPT), alongside percutaneous coronary intervention (PCI), is central to the prevention of ischemic events following acute coronary syndrome (ACS). However, response to therapy can vary due to several factors including CYP2C19 gene variation, which shows increased prevalence in East Asian populations. DAPT responsiveness can be assessed using techniques such as light transmission aggregometry (LTA), VerifyNow(®) and thromboelastography with the PlateletMapping(®) assay, and there is increasing focus on the utility of platelet function testing to guide individualized treatment. This systematic literature review of one English and three Chinese language databases was conducted to evaluate the evidence for the utility of thromboelastography in ACS/PCI in East Asia. The search identified 42 articles from the English language and 71 articles from the Chinese language databases which fulfilled the pre-determined inclusion criteria, including 38 randomized controlled trials (RCTs). The identified studies explored the use of thromboelastography compared to LTA and VerifyNow in monitoring patient responsiveness to DAPT, as well as predicting ischemic risk, with some studies suggesting that thromboelastography is better able to detect low DAPT response than LTA. Other studies, including one large RCT, described the use of thromboelastography in guiding the escalation of DAPT, with some evidence suggesting that such protocols reduce ischemic events without increasing the risk of bleeding. There was also evidence suggesting that thromboelastography can be used to identify individuals with DAPT hyporesponsiveness genotypes and could potentially guide treatment by adjusting therapy in patients depending on responsiveness.
2.
Thromboelastography-guided therapy improves patient blood management and certain clinical outcomes in elective cardiac and liver surgery and emergency resuscitation: a systematic review and analysis
Dias JD, Sauaia A, Achneck HE, Hartmann J, Moore EE
Journal of thrombosis and haemostasis : JTH. 2019
Abstract
BACKGROUND Thromboelastography (TEG((R)) 5000/6s Thrombelastograph((R)) Hemostasis Analyzer; Haemonetics((R)) , Braintree, MA) is a point-of-care system designed to monitor and analyze the entire coagulation process in real time. TEG((R)) -guided therapy has been shown to be valuable in a variety of surgical settings. OBJECTIVE While guidelines recommend viscoelastic monitoring for the management of perioperative bleeding, there are no meta-analyses specifically evaluating the effects of TEG((R)) -guided transfusion on patient outcomes. PATIENTS/METHODS We searched MEDLINE (PubMed) and EMBASE for original articles using TEG((R)) versus control in a perioperative setting for inclusion in this systematic review. We identified nine eligible randomized controlled trials (RCTs) in two elective surgery settings (cardiac surgery and liver surgery), but only one RCT in the emergency setting. RESULTS In the elective surgery study meta-analysis, platelet (p=0.004), plasma (p<0.001) and red blood cell transfusion (p=0.14), operating room length of stay (LoS) (p=0.005), intensive care unit LoS (p=0.04) and bleeding rate (p=0.002) were reduced with TEG((R)) -guided transfusion versus control. Although blood product use was reduced, rates of mortality remained comparable between TEG((R)) and control groups. In the emergency setting evaluation, the RCT reported lower mortality in the TEG((R)) group versus the controls (p=0.049). In addition, there was a significant reduction in platelet and plasma transfusion (p=0.04 and p=0.02, respectively), and the number of ventilator-free days increased in the TEG((R)) group compared with the controls (p=0.10). CONCLUSIONS This systematic review and analysis indicate that TEG((R)) -guided hemostatic therapy can enhance blood product management and improve key patient outcomes, including LoS, bleeding rate and mortality. This article is protected by copyright. All rights reserved.