A Guideline for Transfusion Based on TEG Results.

A Guideline for Transfusion Based on TEG Results. C.22. What is thromboelastometry? How can it guide transfusion? C.22. What is thromboelastometry? How can it guide transfusion?

«Flowchart»

Patient bleeding?

Yes

End

50 mg protamine to reverse excess heparin

Do you need to transfuse?

TEG^® results

^®

Normal TEG^® results

^® Normal

Abnormal TEG^® results

^® Abnormal

Run Platelet Mapping^® assess level of inhibition

^®

Re-exploration

Have they been on antiplatelet therapy?

Yes

Reaction time (R-time)

Reaction time

Maximum amplitude (MA)

Maximum amplitude

Clot lysis (LY30)

Clot lysis

1 pool platelets

Primary fibrinolysis

Heparinase
R normal, plain
R extended

Heparinase

Pln R = Hep R
and
R 11 to 14 min

Pln R = Hep R

Pln R = Hep R
and
R > 14 min

Pln R = Hep R

2 units FFP

2 units FFP + check fibrinogen

If fibrinogen <1.5 g/dL 10 units cryo
If > 1.5 g/dL 2 units FFP

MA 40 to 47 mm
G 3.3 to 4.4 K

MA 40 to 47 mm

MA <40 mm
or
G <3.3 K

MA <40 mm

2 pools platelets

LY30 >7.5% with CI <1.0

LY30 >7.5%

LY30 >7.5% with CI >3.0

LY30 >7.5%

Secondary fibrinolysis

Tranexamic acid 1 to 2 g/kg

Anticoagulant of choice seek advice

CI, coagulation index; FFP, fresh frozen plasma; G, clot elasticity; K, kinetics; Pln, plain.