Thromboelastography for Diagnosing Coagulopathy and Guiding Blood Transfusion

Timely response to coagulopathy could provide the best objective evidence to guide therapies, predict bleeding and thrombotic risk, reduce the cost of care, and improve outcomes. This review sought to identify the diagnostic characteristics of Thromboelastography (TEG) in bleeding and hypercoagulability populations and the guiding principle for blood components transfusion. We reviewed the research studies of TEG in bleeding diseases (trauma, cardiac surgery, and liver surgery) and hypercoagulability populations (obstetric patients, older patients, and infection patients). We also summarized its guiding principle for blood components transfusion (whole blood, platelet, plasma, and cryoprecipitate). Overall, TEG can diagnose surgical bleeding and hypercoagulability population by recognizing the alterations of the coagulation system, e.g., long R, flat α angle, thin maximum amplitude (MA), and increased LY30 in initial severe bleeding trauma patient; shortened R, increased α and MA, shortened K when patient with endothelial injury; decrescent K, increscent α angle, MA and coagulation index (CI) in people over 50 years. TEG can also guide blood transfusion. For example, TEG MA < 55 mm can be a threshold for platelet transfusions for thrombocytopenia patients; one unit of FFP shortens the R time by 5 minutes with a ratio of 5 mins/U of FFP for high-responder surgical patients. TEG can help diagnose coagulopathy and guide blood transfusion. However, there are still challenges and prospects for the clinical applications of TEG, such as achieving faster results and developing realistic blood flow detection environments. We expect that advances in mathematics, physics, and medical analysis will be integrated into patient blood management.