Establishing a reference range for thromboelastography maximum amplitude in patients administrating with antiplatelet...

We aimed to establish the reference range of thromboelastograph (TEG) maximum amplitude (MA) in patients taking antiplatelet drugs.

Between August 2015 and July 2018, a total of 4614 patients administrating with antiplatelet drugs (clopidogrel and aspirin) were retrospectively analyzed in this study. For MA_A parameter, we used the 10th and 90th percentiles to establish a reference range. The Spearman correlation was used for the correlation analysis among the inhibition rate of adenosine diphosphate (ADP%) and MA_ADP , inhibition rate of arachidonic acid (AA%) and MA_AA . Then, through receiver operating characteristic (ROC) curve analysis of the best cutoff point, the reference ranges of MA_ADP and MA_AA could be deduced. Consistency evaluation was performed by statistical analysis of ADP% and MA_ADP , AA% and MA_AA pairing for 4459 patients.

The reference range of MA_A was 8.1-25.8 mm. The reference range of MA_ADP was 19.8-43.2 mm, and the corresponding sensitivity of two endpoints was 0.796, 0.856 and specificity were 0.897, 0.904, respectively. The reference range of MA_AA was 18.9-37.7 mm, and the corresponding sensitivity of two endpoints was 0.819, 0.829 and specificity were 0.922, 0.896, respectively. The inconsistency rate of ADP% and MA_ADP , and AA% and MA_AA was 20.1% (898 cases) and 16.6% (738 cases), respectively.

The reference range of MA_ADP and MA_AA established by us were better in sensitivity and specificity. MA_ADP and MA_AA were more accurate than conventional inhibition rate analysis in guidance of antiplatelet therapy, especially in patients with excessive low MA or high MA_A .