Thromboelastography and routine coagulation tests in the management of coagulation during ECMO therapy: a comparative study

• Published in: Zhongguo shuxue zazhi
• Main Authors: Hao LI, Sina LI, Huini HUANG, Ziji YANG, Huiqiong XIE, Ruixian LUO, Shulin XIANG, Hailan LI, Zhuning MO
• Format: Article
• Language: Chinese
• Published: Institute of Blood Transfusion of Chinese Academy of Medical Sciences 2024-06-01
• Subjects: extracorporeal membrane oxygenation(ecmo); thromboelastography(teg); routine coagulation tests; anticoagulation
• Online Access: https://www.cjbt.cn/thesisDetails#10.13303/j.cjbt.issn.1004-549x.2024.06.001&lang=en

Objective To investigate the correlation and consistency between the parameters of thromboelastography(TEG) and routine coagulation tests, and to evaluate the application value of the two methods in heparin anticoagulation monitoring and coagulation function monitoring in patients receiving extracorporeal membrane oxygenation(ECMO) therapy. Methods A total of 138 patients who recieved ECMO in the Department of Critical Care Medicine of the People′s Hospital of Guangxi Zhuang Autonomous Region from October 2021 to December 2022 were selected. A total of 317 pairs of ordinary TEG and heparinase-modified TEG(hmTEG) parameters measured simultaneously were analyzed for correlation and consistency with activated partial thromboplastin time(APTT), fibrinogen(Fib), and platelet count(Plt), and the parameters tested when ECMO was established and 24 hours after ECMO operation were compared. Results The correlation coefficient between R values and APTT of hmTEG(r=0.441, P<0.05) was lower than that of ordinary TEG(r=0.547, P<0.05). The parameters α-Angle and K value of ordinary TEG were not correlated with Fib(P>0.05), while as for hmTEG, the correlation was 0.359(P<0.05) and -0.343(P<0.05), respectively. The correlation between MA value of hmTEG and Plt was 0.456(P<0.05), which was much lower than its correlation with Fib(r=0.715, P<0.05). APTT and hmTEG had moderate agreement in judging the anticoagulant effect of UFH(P<0.05). Plt at 24 hours after ECMO was significantly lower than that at establishment of ECMO(P<0.05). Fib, APTT and hmTEG parameters were not significantly different between the two groups(P>0.05). Conclusion The parameters of hmTEG can better reflect the real level of coagulation factors in patients receiving ECMO. The results of hmTEG and APTT are complementary to assess whether heparin in ECMO patients is overdosed, and hmTEG has unique advantages. Routine coagulation tests and TEG cannot replace each other, and the combination of them can achieve better anticoagulation and coagulation management.