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In this episode, episode 86, I welcome Dr. Bob Sikorski back to the show to discuss thromboelastography (TEG) and thromboelastometry (ROTEM). We discuss how they work, what they tell us and how we can use them.
CME: https://earnc.me/hUuIFX
Example TEG:
Hi again Dr. Wolpaw and Dr. Sikorski,
Re-visiting this topic from my comment back in February and Dr. Sikorski’s current discussion of selective TXA administration, fibrinolysis shutdown, and increased incidence of VTE, he references the group in Denver and their research into this. In addition to the references you listed back on the page for Episode 69 is there any other articles either of you could suggest, specifically addressing the potential increased incidence of VTE and TXA. I found the Moore articles on fibrinolysis shutdown and selective TXA but could not find anything on the incidence of VTE with TXA and TEG parameters.
As always, thank you very much.
Vincent
These are the additional references that Dr. Sikorski recommends:
Meizoso et al.A simplified stratification system for venous thromboembolism risk in severely injured trauma patients. Journal of surgical research. 2017:207; 138-144.
Moore et al. Hyperfibrinolysis, physiologic fibrinolysis, and fibrinolysis shutdown: The spectrum of postinjury fibrinolysis and relevance to antifibrinolytic therapy. J Trauma Acute Care Surg. 2014 December ; 77(6): 811–817.
Johnston LR et al. Evaluation of Military Use of Tranexamic Acid and Associated Thromboembolic Events. JAMA Surg. 2018;153(2):169-175.
Thanks so much. Would love an episode on anticoagulant reversals (indications, concerns, management options for emergencies — FFP/platelets, factors, concentrates, etc).
Thank you for this nice explanation of TEG. Our institution has been using TEG to assess risk of embolic events in COVID patients and giving anticoagulant/antiplatelet treatment based on TEG findings correlated with other factors such as d-dimers and clinical picture. Do you have any opinion about this or guidelines on how this can be used?
We’re doing the same, and I think it makes sense, but I think it’s still too new to have definitive data.