The Effect of Antiplatelet Agents on Thromboelastography

Area of Science:

• Hemostasis and Thrombosis
• Point-of-Care Testing
• Pharmacology

Background:

• Thromboelastography (TEG) assesses clot kinetics, but its response to antiplatelet agents is under-researched.
• Antiplatelet agents are widely used, necessitating understanding of their impact on hemostasis.
• Limited data exists on how common antiplatelet medications affect overall clot kinetics.

Purpose of the Study:

• To investigate the relationship between antiplatelet agent use and clot kinetics measured by TEG.
• To compare TEG parameters in patients on dual antiplatelet therapy versus aspirin monotherapy and controls.
• To inform clinical practice regarding blood product resuscitation in patients on antiplatelet medications.

Main Methods:

• Retrospective analysis of adult patients undergoing TEG between February 2018 and July 2020.
• Exclusion criteria included recent anticoagulants, transfusions, incomplete TEG, COVID-19, and liver failure.
• Patients were stratified into control, aspirin monotherapy, and dual antiplatelet therapy groups.

Main Results:

• Dual antiplatelet therapy was associated with significantly higher fibrinogen levels compared to controls (481.5 vs 408.1 mg/dL, P=.013).
• Patients on dual antiplatelets showed increased maximal clot strength (63° vs 58.8°, P=.005) and fibrinogen levels (481.5 vs 384.1 mg/dL, P=.005) compared to aspirin monotherapy.
• No significant differences in clot time or maximal clot strength were observed between overall antiplatelet and control groups.

Conclusions:

• Dual antiplatelet therapy increases maximal clot strength and fibrinogen levels compared to controls and aspirin monotherapy.
• These TEG-derived findings suggest potential differences in clot kinetics influenced by antiplatelet regimens.
• Physicians can utilize these insights for more precise blood product resuscitation strategies in patients on antiplatelet agents.