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Updated: May 11, 2026
06:28
Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization
Published on: June 4, 2020
Dabigatran-associated subdural hemorrhage: using thromboelastography (TEG(®)) to guide decision-making
Ron Neyens1, Nicole Bohm, Madelyne Cearley
1Department of Pharmacy, Medical University of South Carolina, Charleston, SC, USA.
Journal of Thrombosis and Thrombolysis
|May 14, 2013
Summary
Managing bleeding emergencies in patients on novel oral anticoagulants like dabigatran is challenging. Thromboelastography (TEG®) may offer valuable insights into clot dynamics for timely interventions.
Area of Science:
- Neurology
- Hematology
- Pharmacology
Background:
- Novel oral anticoagulants (NOACs), such as dabigatran, pose management challenges during hemorrhagic emergencies.
- Assessing coagulation status in patients on NOACs requiring urgent procedures can be complex.
Observation:
- An 84-year-old male on dabigatran presented with a subdural hematoma necessitating neurosurgical intervention.
- Routine coagulation assays, including thrombin time (TT), were prolonged.
- Factor VIII Inhibitor Bypassing Activity (FEIBA) did not normalize TT.
Findings:
- Thromboelastography (TEG®) provided real-time assessment of clot dynamics.
- A subdural drain was safely inserted despite a prolonged TT.
- TEG® may offer a more comprehensive view of hemostasis than TT alone.
Implications:
- Exclusive reliance on TT may delay critical interventions in patients on dabigatran.
- TEG® could be a valuable tool for managing hemostasis in dabigatran patients during emergent procedures.
- This case highlights the potential utility of advanced coagulation monitoring in NOAC-related bleeding.
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