Thromboelastography: Clinical Application, Interpretation, and Transfusion Management

The coagulation cascade is a dynamic process dependent on many factors. It involves interaction between primary hemostasis, platelet clot formation, secondary hemostasis, thrombin generation, and fibrinolysis. The assessment of this process is particularly important in the surgical patient to properly manage hemostatic issues. Traditionally, coagulation tests used to guide transfusion management have included platelet count, activated partial thromboplastin time, prothrombin time, international normalized ratio, and activated clotting time, among others. Although these tests provide the practitioner with valuable information, they lack the ability to measure platelet function. The ability to measure whole blood coagulation, including platelet function, and not just the number of platelets, can be critical when a healthcare provider is determining what products are appropriate for a particular patient during surgery. One possible solution to this deficit in traditional coagulation monitoring is thromboelastography. Thromboelastography provides a more complete picture of coagulation status, taking into account more factors involved in the clotting process, including platelet function and temperature.