This study was aimed to explore changes of platelet function in vitro during storage by thrombelastography (TEG). 12 units plateletpheresis were randomly selected and stored at 20 to 24 degrees C with agitation. Thrombelastography variable parameters R, K values and maximal amplitude (MA) were measured on 1, 2, 3, 4, 5 days of platelet storage. Platelet concentration, mean platelet volume (MPV), hypotonic shock response (HSR), CD62p expression and CD62p reexpression on platelet surface were detected at the same time. Changes of platelet function in virto were systematically evaluated by above-mentioned indexes. The results showed that MPV augmented slightly with prolongation of preserved time (p > 0.05), and CD62p expression on platelet surface increased remarkably (p < 0.01), while CD62p reexpression decreased gradually (p < 0.01). There were no significant differences in HSR level of platelets during storage (p > 0.05). R value increased with prolongation of preserved time (p < 0.01). There were no obvious changes on K value and alpha Angle during storage (p > 0.05). There were no obvious changes in MA from 1 to 4 days, and MA decreased slightly on day 5 (p < 0.05). It is concluded that there was no significant change in MA and HSR which reflects comprehensive coagulation of platelets during storage. Platelets on the end of storage have excellent function of hemostasis; Thrombelastography parameter MA value can be used as a valuable indicator for evaluation of platelet function in vitro during storage.
Blood Platelets ; physiology ; Blood Preservation ; Humans ; Platelet Function Tests ; methods ; Thrombelastography

Viscoelastic coagulation tests provide simultaneous measurements of multiple aspects of whole-blood coagulation, including interactions between the plasma components and cellular components of the coagulation cascade. This can be carried out immediately using a point of care technique. Viscoelastic tests could predict the patient's outcome, including mortality, and detect coagulopathy more sensitively, resulted in reduced blood loss. The transfusion strategy based on the viscoelastic parameters rather than a conventional coagulation test has been shown to reduce the transfusion requirements. Although there are concerns about the reliability and accuracy of this method, viscoelastic tests, including ROTEM, would be a useful method to guide patient blood management strategies.
Blood Coagulation Disorders ; Blood Coagulation Tests ; Blood Transfusion ; Humans ; Methods ; Mortality ; Plasma ; Point-of-Care Systems ; Thrombelastography

OBJECTIVES: The number of gestational women has been increased in recent years, resulting in more adverse pregnancy outcomes. It is crucial to assess the coagulation function of pregnant women and to intervene in a timely manner. This study aims to analyze the influencing factors on thrombelastography (TEG) and explore the evaluation of TEG for gestational women. METHODS: A retrospective study was conducted on 449 pregnant women who were hospitalized in the obstetrics department in Xiangya Hospital of Central South University from 2018 to 2020. We compared the changes on the TEG parameters among normal pregnant women between different age groups, different ingravidation groups, and different stages of pregnancy groups. The influence on TEG of hypertensive disorders in pregnancy (HDP) and gestational diabetes mellitus (GDM) as well as two diseases synchronization was explored. RESULTS: Compared with the normal second trimester women, the R values and K values of TEG were increased, and α angle, CI values and LY30 values were decreased in third trimester women (all P<0.05). Compared with normal group, the R values and CI values of TEG of the HDP group have significant difference (both P<0.05). There were no significant difference of TEG between the GDM group, the HDP combined with GDM group and the normal group (all P>0.05). Multiple linear regression analysis showed that the influencing factors for R value in TEG were weeks of gestation (P<0.001) and mode of conception (P<0.05), for α angle was weeks of gestation (P<0.05), for MA value was mode of conception (P<0.05), and for CI value was weeks of gestation (P<0.05). The analysis of correlation between TEG with platelet (PLT) and coagulation routines represented that there was a correlation between TEG R values and activated partial thromboplastin time (APTT) (P<0.01), and negative correlation between TEG CI values and APTT (P<0.05). There was a negative correlation between TEG K values and FIB (P<0.05). The correlation of α angle (P<0.05), MA values (P<0.01) and CI values (P<0.05) with FIB were positive respectively. CONCLUSIONS The TEG parameters of 3 stages of pregnancy were different. The different ingravidation approach has effect on TEG. The TEG parameters were consistent with conventional coagulation indicators. The TEG can be used to screen the coagulation status of gestational women, recognize the abnormalities of coagulation and prevent the severe complication timely.
Female ; Humans ; Pregnancy ; Thrombelastography/methods* ; Blood Coagulation Tests/methods* ; Retrospective Studies ; Blood Coagulation ; Blood Platelets ; Diabetes, Gestational/diagnosis*

OBJECTIVE: To investigate the age distribution of Mongolian patients with cerebral infarction caused by thrombosis and the correlation and consistency between thromboelastography (TEG) and four parameters of coagulation. METHODS: The age distribution of 298 Mongolian patients with cerebral infarction treated in Affiliated Hospital of Inner Mongolia Minzu University from January 2020 to December 2021 and their TEG, four items of routin coagulation and platelet count were analyzed retrospectively. The correlation and consistency of above-mentioned two detection methods were statistically analyzed. RESULTS: The onset age of 298 Mongolian patients with cerebral infarction was mainly 61-70 years old, accounting for 38.3%, followed by 51-60 years old, accounting for 26.8%. The R time detected by TEG was linearly correlated with PT and APTT（r=0.186，r=0.152）. K value, MA value and α-Angle measured by TEG was linearly correlated with Fib (r=-0.364，r=0.616，r=0.359), K value, MA value and α-Angle measured by TEG was linearly correlated with Plt (r=0.318，r=0.519，r=0.301). The R time detected by TEG was consistent with PT and APTT, and the Kappa values were 0.252 (P<0.001), 0.336 (P<0.001). K, MA, and α-Angle measured by TEG was consistent with Fib, the Kappa values were 0.265 (P<0.001), 0.289 (P<0.001) and 0.290 (P<0.001), respectively; K、MA and α-Angle measured by TEG was consistent with Plt, the Kappa values were 0.276 (P<0.001), 0.285 (P<0.001) and 0.302 (P<0.001), respectively. CONCLUSION The onset age of Mongolian patients with cerebral infarction caused by thrombosis is mainly 61-70 years old, followed by 51-60 years old. The onset age shows a younger trend. There is a significant correlation between TEG and coagulation, but the consistency is weak, therefore, the two methods can not be replaced each other.
Aged ; Blood Coagulation ; Blood Coagulation Tests/methods* ; Cerebral Infarction ; Humans ; Middle Aged ; Retrospective Studies ; Thrombelastography/methods* ; Thrombosis

PURPOSE: In this prospective study, the effects of fresh frozen plasma (FFP) included in pump priming for congenital heart surgery in infants and children on post-bypass coagulation profiles were evaluated. MATERIALS AND METHODS: Either 20% albumin (50-100 mL) or FFP (1-2 units) was added to pump priming for patients randomly allocated into control or treatment groups, respectively. Hematologic assays, including functional fibrinogen level, and rotational thromboelastometry (ROTEM(R)) were measured before skin incision (baseline), after weaning from cardiopulmonary bypass (CPB) and heparin reversal, and at 24 hours (h) in the intensive care unit (ICU). RESULTS: All the baseline measurements were comparable between the control and treatment groups of infants and children. After heparin reversal, however, significantly higher fibrinogen levels and less reduced ROTEM parameters, which reflect clot formation and firmness, were demonstrated in the treatment groups of infants and children. At 24 h in the ICU, hematologic assays and ROTEM measurements were comparable between the control and treatment groups of infants and children. Transfusion requirements, excluding FFP in pump prime, and postoperative bleeding were comparable between the control and treatment groups of infants and children. CONCLUSION: Although clinical benefits were not clearly found, the inclusion of FFP in pump priming for congenital heart surgery in infants and children was shown to improve the hemodilution-related hemostatic dysfunction immediately after weaning from CPB and heparin reversal.
Adolescent ; *Blood Coagulation ; Cardiac Surgical Procedures ; Cardiopulmonary Bypass/methods ; Child ; Child, Preschool ; Female ; Fibrinogen/*metabolism ; Heart Defects, Congenital/*surgery ; Humans ; Infant ; Male ; *Plasma ; Postoperative Period ; Thrombelastography/methods

ABNORMALITIES during pregnancy are regarded as pathological pregnancy. Early detection of anomalies is urgent to take measures as soon as possible to prevent serious pregnancy complications. Procoagulant-anticoagulant imbalance is often the pathological basis of many pathological pregnancy conditions, leading to a hypercoagulable state. We compared the thromboelastographic parameters between pathological pregnancy and normal pregnancy patients, evaluated the value of thromboelastography in early detecting pathological pregnancy and predicting postpartum hemorrhage.
Diabetes, Gestational ; blood ; Female ; Humans ; Postpartum Hemorrhage ; blood ; prevention & control ; Pre-Eclampsia ; blood ; Pregnancy ; Pregnancy Complications, Hematologic ; blood ; Thrombelastography ; methods ; Venous Thrombosis ; blood

Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic method and enables to assess viscoelastic profiles of whole blood in various clinical settings. ROTEM-guided bleeding management has become an essential part of patient blood management (PBM) which is an important concept in improving patient safety. Here, ROTEM testing and hemostatic interventions should be linked by evidence-based, setting-specific algorithms adapted to the specific patient population of the hospitals and the local availability of hemostatic interventions. Accordingly, ROTEM-guided algorithms implement the concept of personalized or precision medicine in perioperative bleeding management (‘theranostic’ approach). ROTEM-guided PBM has been shown to be effective in reducing bleeding, transfusion requirements, complication rates, and health care costs. Accordingly, several randomized-controlled trials, meta-analyses, and health technology assessments provided evidence that using ROTEM-guided algorithms in bleeding patients resulted in improved patient's safety and outcomes including perioperative morbidity and mortality. However, the implementation of ROTEM in the PBM concept requires adequate technical and interpretation training, education and logistics, as well as interdisciplinary communication and collaboration.
Cooperative Behavior ; Education ; Health Care Costs ; Hemorrhage ; Humans ; Interdisciplinary Communication ; Methods ; Mortality ; Organization and Administration ; Patient Safety ; Point-of-Care Systems ; Precision Medicine ; Technology Assessment, Biomedical ; Thrombelastography

BACKGROUNDPlatelet function tests are widely used in clinical practice to guide personalized antiplatelet therapy. In China, the thromboelastography (TEG) test has been well accepted in clinics, whereas VerifyNow, mainly used for scientific research, has not been used in routine clinical practice. The aim of the current study was to compare these two point-of-care platelet function tests and to analyze the consistency between the two tests for evaluating on-clopidogrel platelet reactivity in Chinese acute myocardial infarction patients undergoing percutaneous coronary intervention (PCI).

METHODSA total of 184 patients admitted to Fuwai Hospital between August 2014 and May 2015 were enrolled in the study. On-clopidogrel platelet reactivity was assessed 3 days after PCI by TEG and VerifyNow using adenosine diphosphate as an agonist. Based on the previous reports, an inhibition of platelet aggregation (IPA) <30% for TEG or a P2Y12 reaction unit (PRU) >230 for VerifyNow was defined as high on-clopidogrel platelet reactivity (HPR). An IPA >70% or a PRU <178 was defined as low on-clopidogrel platelet reactivity (LPR). Correlation and agreement between the two methods were analyzed using the Spearman correlation coefficient (r) and kappa value (κ), respectively.

RESULTSOur results showed that VerifyNow and TEG had a moderate but significant correlation in evaluating platelet reactivity (r = -0.511). A significant although poor agreement (κ = 0.225) in identifying HPR and a significantly moderate agreement in identifying LPR (κ = 0.412) were observed between TEG and VerifyNow. By using TEG as the reference for comparison, the cutoff values of VerifyNow for the Chinese patients in this study were identified as PRU >205 for HPR and PRU <169 for LPR.

CONCLUSIONSBy comparing VerifyNow to TEG which has been widely used in clinics, VerifyNow could be an attractive alternative to TEG for monitoring on-clopidogrel platelet reactivity in Chinese patients.

Adenosine Diphosphate ; therapeutic use ; Aged ; Aspirin ; therapeutic use ; Blood Platelets ; drug effects ; China ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; drug therapy ; surgery ; Percutaneous Coronary Intervention ; methods ; Platelet Aggregation ; drug effects ; Platelet Aggregation Inhibitors ; therapeutic use ; Point-of-Care Systems ; Receptors, Purinergic P2Y12 ; metabolism ; Thrombelastography ; Ticlopidine ; analogs & derivatives ; therapeutic use