Semin Thromb Hemost 2010; 36(7): 699-706
DOI: 10.1055/s-0030-1265286
© Thieme Medical Publishers

Clinical Utility of Thromboelastography: One Size Does Not Fit All

Julie Wegner1 , 2 , Mark A. Popovsky2 , 3
  • 1Midwestern University, Glendale, Arizona
  • 2Haemonetics Corporation, Braintree, Boston, Massachusetts
  • 3Harvard Medical School and Beth Israel Hospital, Boston, Massachusetts
Further Information

Publication History

Publication Date:
26 October 2010 (online)

ABSTRACT

Coagulation management requires the balancing of different components that contribute to clot formation. These components include the interactions between platelets, procoagulant, anticoagulant, and fibrinolytic factors. The cause of bleeding or thrombotic events is often multifactorial; however, the tests clinicians most frequently use to assess hemostasis do not reflect the complexity of the coagulation system. The paucity of global measurements of hemostasis has resulted in either an empirical or a one-size-fits-all approach to treatment. In contrast, thromboelastography is a test that monitors the different phases of clot formation and lysis, providing the clinician with a tool for making informed therapeutic decisions. This review provides an overview of thromboelastography in the management of hypocoagulable and hypercoagulable conditions.

REFERENCES

  • 1 Roberts H R, Monroe D M, Escobar M A. Current concepts of hemostasis: implications for therapy.  Anesthesiology. 2004;  100(3) 722-730
  • 2 Monroe D M, Hoffman M. What does it take to make the perfect clot?.  Arterioscler Thromb Vasc Biol. 2006;  26(1) 41-48
  • 3 Gallimore M J, Harris S L, Tappenden K A, Winter M, Jones D W. Urokinase induced fibrinolysis in thromboelastography: a model for studying fibrinolysis and coagulation in whole blood.  J Thromb Haemost. 2005;  3(11) 2506-2513
  • 4 Despotis G, Eby C, Lublin D M. A review of transfusion risks and optimal management of perioperative bleeding with cardiac surgery.  Transfusion. 2008;  48(1, Suppl) 2S-30S
  • 5 Mann K G, Brummel-Ziedins K, Undas A, Butenas S. Does the genotype predict the phenotype? Evaluations of the hemostatic proteome.  J Thromb Haemost. 2004;  2(10) 1727-1734
  • 6 Karnicki K, Owen W G, Miller R S, McBane II R D. Factors contributing to individual propensity for arterial thrombosis.  Arterioscler Thromb Vasc Biol. 2002;  22(9) 1495-1499
  • 7 Vanschoonbeek K, Feijge M A, Van Kampen R J et al.. Initiating and potentiating role of platelets in tissue factor-induced thrombin generation in the presence of plasma: subject-dependent variation in thrombogram characteristics.  J Thromb Haemost. 2004;  2(3) 476-484
  • 8 Hertfelder H J, Bös M, Weber D, Winkler K, Hanfland P, Preusse C J. Perioperative monitoring of primary and secondary hemostasis in coronary artery bypass grafting.  Semin Thromb Hemost. 2005;  31(4) 426-440
  • 9 Stover E P, Siegel L C, Parks R Institutions of the Multicenter Study of Perioperative Ischemia Research Group et al. Variability in transfusion practice for coronary artery bypass surgery persists despite national consensus guidelines: a 24-institution study.  Anesthesiology. 1998;  88(2) 327-333
  • 10 Despotis G J, Joist J H, Goodnough L T. Monitoring of hemostasis in cardiac surgical patients: impact of point-of-care testing on blood loss and transfusion outcomes.  Clin Chem. 1997;  43(9) 1684-1696
  • 11 Engoren M C, Habib R H, Zacharias A, Schwann T A, Riordan C J, Durham S J. Effect of blood transfusion on long-term survival after cardiac operation.  Ann Thorac Surg. 2002;  74(4) 1180-1186
  • 12 Rao S V, Jollis J G, Harrington R A et al.. Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes.  JAMA. 2004;  292(13) 1555-1562
  • 13 Spiess B D, Royston D, Levy J H et al. Platelet transfusions during coronary artery bypass graft surgery are associated with serious adverse outcomes.  Transfusion. 2004;  44(8) 1143-1148
  • 14 Ganter M T, Hofer C K. Coagulation monitoring: current techniques and clinical use of viscoelastic point-of-care coagulation devices.  Anesth Analg. 2008;  106(5) 1366-1375
  • 15 Tripodi A, Chantarangkul V, Mannucci P M. Acquired coagulation disorders: revisited using global coagulation/anticoagulation testing.  Br J Haematol. 2009;  147(1) 77-82
  • 16 Mann K G, Butenas S, Brummel K. The dynamics of thrombin formation.  Arterioscler Thromb Vasc Biol. 2003;  23(1) 17-25
  • 17 Essell J H, Martin T J, Salinas J, Thompson J M, Smith V C. Comparison of thromboelastography to bleeding time and standard coagulation tests in patients after cardiopulmonary bypass.  J Cardiothorac Vasc Anesth. 1993;  7(4) 410-415
  • 18 Kaufmann C R, Dwyer K M, Crews J D, Dols S J, Trask A L. Usefulness of thrombelastography in assessment of trauma patient coagulation.  J Trauma. 1997;  42(4) 716-720 discussion 720-722
  • 19 Kamal A H, Tefferi A, Pruthi R K. How to interpret and pursue an abnormal prothrombin time, activated partial thromboplastin time, and bleeding time in adults.  Mayo Clin Proc. 2007;  82(7) 864-873
  • 20 Rooney M M, Farrell D H, van Hemel B M, de Groot P G, Lord S T. The contribution of the three hypothesized integrin-binding sites in fibrinogen to platelet-mediated clot retraction.  Blood. 1998;  92(7) 2374-2381
  • 21 Mousa S A, Bozarth J M, Seiffert D, Feuerstein G Z. Using thrombelastography to determine the efficacy of the platelet glycoprotein IIb/IIIa antagonist, roxifiban, on platelet/fibrin-mediated clot dynamics in humans.  Blood Coagul Fibrinolysis. 2005;  16(3) 165-171
  • 22 Carr Jr M E, Carr S L. Fibrin structure and concentration alter clot elastic modulus but do not alter platelet mediated force development.  Blood Coagul Fibrinolysis. 1995;  6(1) 79-86
  • 23 Chakroun T, Gerotziafas G T, Seghatchian J, Samama M M, Hatmi M, Elalamy I. The influence of fibrin polymerization and platelet-mediated contractile forces on citrated whole blood thromboelastography profile.  Thromb Haemost. 2006;  95(5) 822-828
  • 24 Gottumukkala V N, Sharma S K, Philip J. Assessing platelet and fibrinogen contribution to clot strength using modified thromboelastography in pregnant women.  Anesth Analg. 1999;  89(6) 1453-1455
  • 25 Goto S. Understanding the mechanism and prevention of arterial occlusive thrombus formation by anti-platelet agents.  Curr Med Chem Cardiovasc Hematol Agents. 2004;  2(2) 149-156
  • 26 Oshita K, Az-ma T, Osawa Y, Yuge O. Quantitative measurement of thromboelastography as a function of platelet count.  Anesth Analg. 1999;  89(2) 296-299
  • 27 Bowbrick V A, Mikhailidis D P, Stansby G. Influence of platelet count and activity on thromboelastography parameters.  Platelets. 2003;  14(4) 219-224
  • 28 Bochsen L, Wiinberg B, Kjelgaard-Hansen M, Steinbrüchel D A, Johansson P I. Evaluation of the TEG platelet mapping assay in blood donors.  Thromb J. 2007;  5 3
  • 29 Nielsen V G, Geary B T, Baird M S. Evaluation of the contribution of platelets to clot strength by thromboelastography in rabbits: the role of tissue factor and cytochalasin D.  Anesth Analg. 2000;  91(1) 35-39
  • 30 Collet J P, Shuman H, Ledger R E, Lee S, Weisel J W. The elasticity of an individual fibrin fiber in a clot.  Proc Natl Acad Sci U S A. 2005;  102(26) 9133-9137
  • 31 Gurbel P A, Bliden K P, Guyer K et al.. Platelet reactivity in patients and recurrent events post-stenting: results of the PREPARE POST-STENTING Study.  J Am Coll Cardiol. 2005;  46(10) 1820-1826
  • 32 McCrath D J, Cerboni E, Frumento R J, Hirsh A L, Bennett-Guerrero E. Thromboelastography maximum amplitude predicts postoperative thrombotic complications including myocardial infarction.  Anesth Analg. 2005;  100(6) 1576-1583
  • 33 Marchal G, Leroux M, Samama M. Atlas of Thrombodynamography. Niles, IL; Haemoscope Corporation 2003
  • 34 Avidan M S, Alcock E L, Da Fonseca J et al.. Comparison of structured use of routine laboratory tests or near-patient assessment with clinical judgement in the management of bleeding after cardiac surgery.  Br J Anaesth. 2004;  92(2) 178-186
  • 35 Shore-Lesserson L, Manspeizer H E, DePerio M, Francis S, Vela-Cantos F, Ergin M A. Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery.  Anesth Analg. 1999;  88(2) 312-319
  • 36 Royston D, von Kier S. Reduced haemostatic factor transfusion using heparinase-modified thrombelastography during cardiopulmonary bypass.  Br J Anaesth. 2001;  86(4) 575-578
  • 37 Ak K, Isbir C S, Tetik S et al. Thromboelastography-based transfusion algorithm reduces blood product use after elective CABG: a prospective randomized study.  J Card Surg. 2009;  24(4) 404-410
  • 38 Westbrook A J, Olsen J, Bailey M, Bates J, Scully M, Salamonsen R F. Protocol based on thromboelastograph (TEG) out-performs physician preference using laboratory coagulation tests to guide blood replacement during and after cardiac surgery: a pilot study.  Heart Lung Circ. 2009;  18(4) 277-288
  • 39 Tuman K J, Spiess B D, McCarthy R J, Ivankovich A D. Comparison of viscoelastic measures of coagulation after cardiopulmonary bypass.  Anesth Analg. 1989;  69(1) 69-75
  • 40 Nuttall G A, Oliver W C, Ereth M H, Santrach P J. Coagulation tests predict bleeding after cardiopulmonary bypass.  J Cardiothorac Vasc Anesth. 1997;  11(7) 815-823
  • 41 Wang J S, Lin C Y, Hung W T et al. Thromboelastogram fails to predict postoperative hemorrhage in cardiac patients.  Ann Thorac Surg. 1992;  53(3) 435-439
  • 42 Davidson S J, McGrowder D, Roughton M, Kelleher A A. Can RoTEM thromboelastometry predict postoperative bleeding after cardiac surgery?.  J Cardiothorac Vasc Anesth. 2008;  22(5) 655-661
  • 43 Spiess B D, Tuman K J, McCarthy R J, DeLaria G A, Schillo R, Ivankovich A D. Thromboelastography as an indicator of post-cardiopulmonary bypass coagulopathies.  J Clin Monit. 1987;  3(1) 25-30
  • 44 Spiess B D, Gillies B S, Chandler W, Verrier E. Changes in transfusion therapy and reexploration rate after institution of a blood management program in cardiac surgical patients.  J Cardiothorac Vasc Anesth. 1995;  9(2) 168-173
  • 45 Welsby I J, Jiao K, Ortel T L et al.. The kaolin-activated Thrombelastograph predicts bleeding after cardiac surgery.  J Cardiothorac Vasc Anesth. 2006;  20(4) 531-535
  • 46 Plotkin A J, Wade C E, Jenkins D H et al.. A reduction in clot formation rate and strength assessed by thrombelastography is indicative of transfusion requirements in patients with penetrating injuries.  J Trauma. 2008;  64(2, Suppl) S64-S68
  • 47 Johansson P I, Swiatek F, Jørgensen L, Jensen L P, Secher N H. Intraoperative platelet and plasma improves survival in patients operated for a rAAA: a follow-up evaluation.  Eur J Vasc Endovasc Surg. 2008;  36(4) 397-400
  • 48 Carroll R C, Craft R M, Langdon R J et al.. Early evaluation of acute traumatic coagulopathy by thrombelastography.  Transl Res. 2009;  154(1) 34-39
  • 49 Beilin Y, Arnold I, Hossain S. Evaluation of the platelet function analyzer (PFA-100) vs. the thromboelastogram (TEG) in the parturient.  Int J Obstet Anesth. 2006;  15(1) 7-12
  • 50 Lombard F W, Welsby I J, Alexander M J, Borel C O. Thromboelastography detects inadequate response to abciximab therapy during stent-assisted cerebral aneurysm coil embolization complicated by stroke.  Neurocrit Care. 2006;  4(1) 32-34
  • 51 Hobson A R, Agarwala R A, Swallow R A, Dawkins K D, Curzen N P. Thrombelastography: current clinical applications and its potential role in interventional cardiology.  Platelets. 2006;  17(8) 509-518
  • 52 Coakley M, Reddy K, Mackie I, Mallett S. Transfusion triggers in orthotopic liver transplantation: a comparison of the thromboelastometry analyzer, the thromboelastogram, and conventional coagulation tests.  J Cardiothorac Vasc Anesth. 2006;  20(4) 548-553
  • 53 Nielsen V G. A comparison of the Thrombelastograph and the ROTEM.  Blood Coagul Fibrinolysis. 2007;  18(3) 247-252
  • 54 Johansson P I. Treatment of massively bleeding patients: introducing real-time monitoring, transfusion packages and thrombelastography (TEG®).  ISBT Sci Series. 2007;  2 159-167
  • 55 Cammerer U, Dietrich W, Rampf T, Braun S L, Richter J A. The predictive value of modified computerized thromboelastography and platelet function analysis for postoperative blood loss in routine cardiac surgery.  Anesth Analg. 2003;  96(1) 51-57
  • 56 Choong C K, Gerrard C, Goldsmith K A, Dunningham H, Vuylsteke A. Delayed re-exploration for bleeding after coronary artery bypass surgery results in adverse outcomes.  Eur J Cardiothorac Surg. 2007;  31(5) 834-838
  • 57 Craft R M, Chavez J J, Bresee S J, Wortham D C, Cohen E, Carroll R C. A novel modification of the Thrombelastograph assay, isolating platelet function, correlates with optical platelet aggregation.  J Lab Clin Med. 2004;  143(5) 301-309
  • 58 Katori N, Szlam F, Levy J H, Tanaka K A. A novel method to assess platelet inhibition by eptifibatide with thrombelastograph.  Anesth Analg. 2004;  99(6) 1794-1799
  • 59 Ren Y H, Yang T S, Wang Y et al.. Evaluation of triple anti-platelet therapy by modified thrombelastography in patients with acute coronary syndrome.  Chin Med J (Engl). 2008;  121(9) 850-852
  • 60 Vila P M, Zafar M U, Badimon J J. Platelet reactivity and nonresponse to dual antiplatelet therapy: a review.  Platelets. 2009;  20(8) 531-538
  • 61 Hobson A R, Qureshi Z, Banks P, Curzen N. Gender and responses to aspirin and clopidogrel: insights using short thrombelastography.  Cardiovasc Ther. 2009;  27(4) 246-252
  • 62 Collyer T C, Gray D J, Sandhu R, Berridge J, Lyons G. Assessment of platelet inhibition secondary to clopidogrel and aspirin therapy in preoperative acute surgical patients measured by Thrombelastography Platelet Mapping.  Br J Anaesth. 2009;  102(4) 492-498
  • 63 Priesman S. The risk of postoperative bleeding in patients receiving clopidogrel can be predicted using modified bed-side thromboelastography.  EACTS Daily News. 2009;  October 20 14
  • 64 Lang T, Johanning K, Metzler H et al.. The effects of fibrinogen levels on thromboelastometric variables in the presence of thrombocytopenia.  Anesth Analg. 2009;  108(3) 751-758
  • 65 Rahe-Meyer N, Solomon C, Winterhalter M et al.. Thromboelastometry-guided administration of fibrinogen concentrate for the treatment of excessive intraoperative bleeding in thoracoabdominal aortic aneurysm surgery.  J Thorac Cardiovasc Surg. 2009;  138(3) 694-702
  • 66 Reinhöfer M, Brauer M, Franke U, Barz D, Marx G, Lösche W. The value of rotation thromboelastometry to monitor disturbed perioperative haemostasis and bleeding risk in patients with cardiopulmonary bypass.  Blood Coagul Fibrinolysis. 2008;  19(3) 212-219
  • 67 Fries D, Innerhofer P, Schobersberger W. Time for changing coagulation management in trauma-related massive bleeding.  Curr Opin Anaesthesiol. 2009;  22(2) 267-274
  • 68 Mittermayr M, Streif W, Haas T et al.. Hemostatic changes after crystalloid or colloid fluid administration during major orthopedic surgery: the role of fibrinogen administration.  Anesth Analg. 2007;  105(4) 905-917
  • 69 Horácek M, Cvachovec K. The effects of cardiopulmonary bypass with hollow fiber membrane oxygenator on blood clotting measured by thromboelastography.  Physiol Res. 2002;  51(2) 145-150
  • 70 Paparella D, Brister S J, Buchanan M R. Coagulation disorders of cardiopulmonary bypass: a review.  Intensive Care Med. 2004;  30(10) 1873-1881
  • 71 Rogers M AM, Blumberg N, Saint S, Langa K M, Nallamothu B K. Hospital variation in transfusion and infection after cardiac surgery: a cohort study.  BMC Med. 2009;  7 37
  • 72 Anderson L, Quasim I, Soutar R, Steven M, Macfie A, Korte W. An audit of red cell and blood product use after the institution of thromboelastometry in a cardiac intensive care unit.  Transfus Med. 2006;  16(1) 31-39
  • 73 Spalding G J, Hartrumpf M, Sierig T, Oesberg N, Kirschke C G, Albes J M. Cost reduction of perioperative coagulation management in cardiac surgery: value of “bedside” thrombelastography (ROTEM).  Eur J Cardiothorac Surg. 2007;  31(6) 1052-1057
  • 74 Fenger-Eriksen C, Ingerslev J, Sørensen B. Fibrinogen concentrate—a potential universal hemostatic agent.  Expert Opin Biol Ther. 2009;  9(10) 1325-1333
  • 75 Fenger-Eriksen C, Jensen T M, Kristensen B S et al.. Fibrinogen substitution improves whole blood clot firmness after dilution with hydroxyethyl starch in bleeding patients undergoing radical cystectomy: a randomized, placebo-controlled clinical trial.  J Thromb Haemost. 2009;  7(5) 795-802
  • 76 Karlsson M, Ternström L, Hyllner M, Baghaei F, Nilsson S, Jeppsson A. Plasma fibrinogen level, bleeding, and transfusion after on-pump coronary artery bypass grafting surgery: a prospective observational study.  Transfusion. 2008;  48(10) 2152-2158
  • 77 Bolliger D, Szlam F, Molinaro R J, Rahe-Meyer N, Levy J H, Tanaka K A. Finding the optimal concentration range for fibrinogen replacement after severe haemodilution: an in vitro model.  Br J Anaesth. 2009;  102(6) 793-799
  • 78 Fenger-Eriksen C, Tønnesen E, Ingerslev J, Sørensen B. Recombinant factor VIIa and fibrinogen display additive effect during in vitro haemodilution with crystalloids.  Acta Anaesthesiol Scand. 2009;  53(3) 332-338
  • 79 Dempfle C E, Kälsch T, Elmas E et al.. Impact of fibrinogen concentration in severely ill patients on mechanical properties of whole blood clots.  Blood Coagul Fibrinolysis. 2008;  19(8) 765-770
  • 80 Huissoud C, Carrabin N, Audibert F et al.. Bedside assessment of fibrinogen level in postpartum haemorrhage by thrombelastometry.  BJOG. 2009;  116(8) 1097-1102
  • 81 Gonano C KS, Panzer O P, Kozek S A et al.. Accuracy of native and activated thromboelastography for assessment of plasma fibrinogen levels.  Anesthesiology. 1998;  89(3A) A912
  • 82 Rahe-Meyer N, Pichlmaier M, Haverich A et al.. Bleeding management with fibrinogen concentrate targeting a high-normal plasma fibrinogen level: a pilot study.  Br J Anaesth. 2009;  102(6) 785-792
  • 83 Jüttner B, Brock J, Weissig A et al.. Dependence of platelet function on underlying liver disease in orthotopic liver transplantation.  Thromb Res. 2009;  124(4) 433-438
  • 84 Warnaar N, Lisman T, Porte R J. The two tales of coagulation in liver transplantation.  Curr Opin Organ Transplant. 2008;  13(3) 298-303
  • 85 Tripodi A, Primignani M, Chantarangkul V et al.. The coagulopathy of cirrhosis assessed by thromboelastometry and its correlation with conventional coagulation parameters.  Thromb Res. 2009;  124(1) 132-136
  • 86 Tripodi A, Primignani M, Chantarangkul V et al.. An imbalance of pro- vs anti-coagulation factors in plasma from patients with cirrhosis.  Gastroenterology. 2009;  137(6) 2105-2111
  • 87 Lerner A B, Sundar E, Mahmood F, Sarge T, Hanto D W, Panzica P J. Four cases of cardiopulmonary thromboembolism during liver transplantation without the use of antifibrinolytic drugs.  Anesth Analg. 2005;  101(6) 1608-1612
  • 88 O'Connor C J, Roozeboom D, Brown R, Tuman K J. Pulmonary thromboembolism during liver transplantation: possible association with antifibrinolytic drugs and novel treatment options.  Anesth Analg. 2000;  91(2) 296-299
  • 89 Gologorsky E, De Wolf A M, Scott V, Aggarwal S, Dishart M, Kang Y. Intracardiac thrombus formation and pulmonary thromboembolism immediately after graft reperfusion in 7 patients undergoing liver transplantation.  Liver Transpl. 2001;  7(9) 783-789
  • 90 Manji M, Isaac J L, Bion J. Survival from massive intraoperative pulmonary thromboembolism during orthotopic liver transplantation.  Br J Anaesth. 1998;  80(5) 685-687
  • 91 Cerutti E, Stratta C, Romagnoli R et al.. Thromboelastogram monitoring in the perioperative period of hepatectomy for adult living liver donation.  Liver Transpl. 2004;  10(2) 289-294
  • 92 Brohi K. Diagnosis and management of coagulopathy after major trauma.  Br J Surg. 2009;  96(9) 963-964
  • 93 Selby R, Geerts W, Ofosu F A et al.. Hypercoagulability after trauma: hemostatic changes and relationship to venous thromboembolism.  Thromb Res. 2009;  124(3) 281-287
  • 94 Johansson P I. Hemostatic strategies for minimizing mortality in surgery with major blood loss.  Curr Opin Hematol. 2009;  16(6) 509-514
  • 95 Johansson P I, Bochsen L, Stensballe J, Secher N H. Transfusion packages for massively bleeding patients: the effect on clot formation and stability as evaluated by Thrombelastograph (TEG).  Transfus Apheresis Sci. 2008;  39(1) 3-8
  • 96 Johansson P I, Stensballe J. Effect of haemostatic control resuscitation on mortality in massively bleeding patients: a before and after study.  Vox Sang. 2009;  96(2) 111-118
  • 97 White N J, Martin E J, Brophy D F, Ward K R. Coagulopathy and traumatic shock: characterizing hemostatic function during the critical period prior to fluid resuscitation.  Resuscitation. 2010;  81(1) 111-116
  • 98 Velik-Salchner C, Streif W, Innerhofer P et al.. Endotoxinemia-induced changes in coagulation as measured by rotation thrombelastometry technique and conventional laboratory tests: results of a pilot study on pigs.  Blood Coagul Fibrinolysis. 2009;  20(1) 41-46
  • 99 Martini W Z, Cortez D S, Dubick M A, Park M S, Holcomb J B. Thrombelastography is better than PT, aPTT, and activated clotting time in detecting clinically relevant clotting abnormalities after hypothermia, hemorrhagic shock and resuscitation in pigs.  J Trauma. 2008;  65(3) 535-543
  • 100 Park M S, Martini W Z, Dubick M A et al.. Thromboelastography as a better indicator of hypercoagulable state after injury than prothrombin time or activated partial thromboplastin time.  J Trauma. 2009;  67(2) 266-275; discussion 275–276
  • 101 Van P Y, Cho S D, Underwood S J, Morris M S, Watters J M, Schreiber M A. Thrombelastography versus AntiFactor Xa levels in the assessment of prophylactic-dose enoxaparin in critically ill patients.  J Trauma. 2009;  66(6) 1509-1515; discussion 1515–1517
  • 102 Spiezia L, Marchioro P, Radu C et al.. Whole blood coagulation assessment using rotation thrombelastogram thromboelastometry in patients with acute deep vein thrombosis.  Blood Coagul Fibrinolysis. 2008;  19(5) 355-360
  • 103 Akay O M, Ustuner Z, Canturk Z, Mutlu F S, Gulbas Z. Laboratory investigation of hypercoagulability in cancer patients using rotation thrombelastography.  Med Oncol. 2009;  26(3) 358-364
  • 104 Bochsen L, Rosengaard L B, Nielsen A B, Steinbrüchel D A, Johansson P I. Platelet hyperreactivity in response to on- and off-pump coronary artery bypass grafting.  J Extra Corpor Technol. 2009;  41(1) 15-19
  • 105 Kashuk J L, Moore E E, Sabel A et al.. Rapid thrombelastography (r-TEG) identifies hypercoagulability and predicts thromboembolic events in surgical patients.  Surgery. 2009;  146(4) 764-772, discussion 772–774
  • 106 Gurbel P A, Bliden K P, Saucedo J F et al.. Bivalirudin and clopidogrel with and without eptifibatide for elective stenting: effects on platelet function, thrombelastographic indexes, and their relation to periprocedural infarction results of the CLEAR PLATELETS-2 (Clopidogrel with Eptifibatide to Arrest the Reactivity of Platelets) study.  J Am Coll Cardiol. 2009;  53(8) 648-657
  • 107 Dai Y, Lee A, Critchley L A, White P F. Does thromboelastography predict postoperative thromboembolic events? A systematic review of the literature.  Anesth Analg. 2009;  108(3) 734-742
  • 108 Perez de Prado A, Cuellas C, Diego A et al.. Influence of platelet reactivity and response to clopidogrel on myocardial damage following percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndrome.  Thromb Res. 2009;  124(6) 678-682
  • 109 Bliden K P, DiChiara J, Tantry U S, Bassi A K, Chaganti S K, Gurbel P A. Increased risk in patients with high platelet aggregation receiving chronic clopidogrel therapy undergoing percutaneous coronary intervention: is the current antiplatelet therapy adequate?.  J Am Coll Cardiol. 2007;  49(6) 657-666

Julie WegnerPh.D. C.P. 

282 E. Scheibe Way

Tucson, AZ 85705

Email: jawrbl@gmail.com

    >