Thromboelastography: a promising alternative to monitor fresh frozen plasma transfusion. A pilot Study in ICU patients

Abstract

Background and ObjectivesMost of the fresh frozen plasma (FFP) transfusions given are inappropriate and are based on abnormal coagulation tests. The objective of our study was to determine whether thromboelastography (TEG) can be used as an alternate to guide and monitor FFP transfusions.MethodsA prospective observational study was conducted, and 28 patients were observed during their ICU stay. Blood samples were collected before and 18–24 h post‐FFP transfusion. Platelet counts and conventional coagulation tests were manually measured, and TEG was performed simultaneously.ResultsOf 28 patients, 27 showed abnormal conventional coagulation tests results. In contrast, only 13/28 showed abnormal TEG before FFP transfusion. Of 28 patients, three experienced bleeding, and significant association of TEG parameters – R time, α angle and maximum amplitude, was observed (P < 0·05). Post‐FFP transfusion, five patients were lost to follow‐up. Of 23 patients, 20 had deranged coagulogram, while 13 patients had deranged TEG results. One patient experienced bleeding symptoms and showed abnormal TEG as well as conventional coagulation test results. Significant changes in K time were found in all patients following FFP transfusion (P < 0·05). Maximum amplitude (MA) showed weak correlation with platelet counts. With respect to bleeding, sensitivity of TEG was similar to conventional coagulation test results. However, the specificity of TEG was found to be higher (60%).ConclusionsThromboelastography can be considered as an effective tool to assess coagulation status of ICU patients. Moreover, TEG is more specific and can therefore decrease the use of inappropriate FFP transfusions.