Shock Syndromes II

TEG Tracing

Characterize

Treatment

Factor deficiency

Plasma

-or-

prothrombin complex concentrate

Platelet dysfunction

Platelet transfusions

-or-

desmopressin

TEG Parameters

Description

Normal Rangea

(kaolin-activated)

Treatment

Reaction (R) time

Time until evidence of a first clot is detected.

Time of latency from start to initial fibrin forma-

tion because of effects of factor VIIa and tissue

factor (time until fibrin clot formation)

3–9 min

Fresh frozen

plasma if

elevated

Kinetics (K)

Time from the end of R (factor initiation and start

of clot formation) until the clot reaches 20 mm

amplitude of clot strength (speed of clot forma-

tion), which represents platelet activity, factor

levels, and fibrinogen

1–3 min

Cryoprecipitate

if elevated

α-Angle

The speed at which fibrin buildup and cross-

linking take place (clot strengthening) and hence

assesses the rate of clot formation

55–78 degrees

Cryoprecipitate

if decreased

Maximum ampli-

tude (MA)

Represents the strongest point of fibrin clot, pre-

dominantly platelets but also fibrinogen (80% of

the MA is derived from platelet function, and the

remaining 20% is derived from fibrin)

51–69 mm

Platelets if

decreased

Estimated percent

lysis or lysis at 30

min (LY30)

Represents the percent decrease in amplitude

30 min after MA and measures the degree of

fibrinolysis

0%–8%

Aminocaproic

acid if increased

aStandard TEG is kaolin-activated, and values differ if native blood is used. TEG using native whole blood is slower (R-time 4–8 min, α-angle 47–74 degrees, MA 55–73

mm, K 1–4 min, and LY30 typically not reported or interpreted).

TEG = thromboelastography.

Information from: Gonzalez E, Pieracci FM, Moore EE, et al. Coagulation abnormalities in the trauma patient: the role of point-of-care thromboelastography. Semin

Thromb Hemost 2010;36:723-37.

ments. (Con’t)