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Correlation of thromboelastography with standard tests of anticoagulation in paediatric patients receiving
D C Alexander1, W W Butt, J D Best
1Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia.
Insights
Thromboelastography (TEG) monitoring in children on extracorporeal life support (ECLS) requires paired samples due to heparin interference. Correlations between TEG and standard tests are weak, necessitating further research for clinical utility.
Area of Science:
- Pediatric Critical Care Medicine
- Hemostasis and Thrombosis
- Extracorporeal Life Support
Background:
- Children on extracorporeal life support (ECLS) face high risks of bleeding and clotting complications.
- Thromboelastography (TEG) is a tool for monitoring coagulation, but its use in heparinized pediatric ECLS patients is not well-defined.
Purpose of the Study:
- To evaluate the utility of thromboelastography (TEG) in monitoring coagulation status in pediatric patients receiving extracorporeal life support (ECLS).
- To assess the correlation between TEG parameters and standard coagulation tests in this specific patient population.
Main Methods:
- Retrospective review of 27 children on ECLS, with 171 paired TEG (kaolin and heparinase) analyses.
- Simultaneous measurement of activated partial thromboplastin time (APTT), platelet count, and activated clotting time (ACT) alongside TEG.
Main Results:
- A significant portion (52%) of kaolin-based TEG samples were uninterpretable due to heparin.
- Weak correlations were observed between TEG (heparinase) and APTT, and between TEG and ACT.
- A stronger correlation was found between TEG (Maximum Amplitude) and platelet count.
Conclusions:
- Paired TEG sample analysis is crucial for heparinized children on ECLS.
- Existing correlations between TEG and standard tests are weak to moderate in this population.
- Prospective studies with simultaneous sampling are needed to establish the clinical utility of TEG in pediatric ECLS.
Unlabelled:
Children requiring extracorporeal life support (ECLS) are at significant risk for thrombotic and haemorrhagic complications. Thromboelastography (TEG) is increasingly being used to assist in monitoring the coagulation status of critically ill patients. Its role in heparinised children receiving ECLS is unknown.
Methods:
A retrospective review of TEG in 27 children (mean age 2 years and 8 months) receiving ECLS in a tertiary paediatric intensive care unit between December 2006 and April 2008. Paired TEG (kaolin and heparinase) analysis was performed on 171 occasions. On all occasions activated partial thromboplastin time (APTT) and platelet count were performed within 4 hours of the TEG (mean 6.5 minutes after TEG). On 158 occasions, the activated clotting time (ACT) was measured simultaneously with TEG.
Results:
The TEG (kaolin) sample was not interpretable due to the heparin effect in 89 (52%) samples. There was a weak correlation between TEG (heparinase) variables and APTT, and between TEG and ACT with a stronger correlation between TEG (Maximum amplitude) and platelet count.
Conclusion:
TEG monitoring should always include paired samples in heparinised children on ECLS. In this heterogeneous population, weak, and moderate correlations exist between TEG and standard haematological tests. Prospective studies, with simultaneous sampling for TEG and conventional laboratory tests, must be performed in order to establish its absolute utility as a clinical tool in this population.
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