Related Experiment Video
Updated: Aug 21, 2025
Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization
Published on: June 4, 2020
Comparison of Thromboelastography Devices TEG®6S Point of Care Device vs. TEG®5000 in Pediatric Patients Undergoing
Sirisha Emani1, Vishnu S Emani2, Fatoumata B Diallo1
1Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts.
Insights
Thromboelastography (TEG) 6S is a reliable point-of-care tool for assessing coagulation in pediatric cardiac surgery patients. Lower maximum amplitude (MA) during rewarming with TEG 6S indicates a higher risk of perioperative bleeding.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Point-of-Care Diagnostics
Background:
- Thromboelastography (TEG) is crucial for predicting bleeding in pediatric cardiac surgery.
- The new TEG 6S system offers point-of-care coagulation analysis.
Purpose of the Study:
- To correlate TEG 5000 results with the new TEG 6S system.
- To assess the association between TEG 6S rewarming maximum amplitude (MA) and perioperative bleeding in pediatric cardiac surgery patients.
Main Methods:
- Retrospective study of pediatric patients (≤18 years) undergoing complex cardiac surgery on cardiopulmonary bypass.
- Comparison of TEG 5000 vs. TEG 6S and TEG 6S-FLEV vs. Clauss-fibrinogen methods using citrate whole-blood samples.
- Linear regression analysis to compare TEG 6S rewarming parameters with perioperative bleeding endpoints.
Main Results:
- Good correlation (Pearson r ≥ 0.7) was observed between TEG 5000 and TEG 6S parameters, and between TEG 6S-FLEV and Clauss-fibrinogen.
- Rewarming TEG 6S MA was independently associated with perioperative bleeding risk (p=0.02).
- A platelet transfusion calculator was developed based on TEG 6S MA.
Conclusions:
- TEG 6S is a comparable and effective point-of-care alternative to TEG 5000 for pediatric cardiac surgery.
- Lower TEG 6S MA during rewarming is linked to increased perioperative bleeding risk.
- TEG analysis during rewarming can guide customized platelet transfusion therapy, reducing bleeding and unnecessary transfusions.
Abstract:
Thromboelastography (TEG) can predict bleeding in pediatric patients undergoing cardiac surgery. We hypothesized that results obtained from TEG®5000 correlate with the new point-of-care TEG®6S system and that TEG®6S rewarming maximum amplitude (MA) is associated with surrogate endpoints for perioperative bleeding in pediatric patients who underwent complex cardiac surgery. We describe a retrospective study of pediatric (≤18 years) patients who underwent complex cardiac surgery on cardiopulmonary bypass. Citrate whole-blood samples were used to compared TEG®5000 vs.TEG®6S and TEG®6S-FLEV (with fibrinogen measurement) vs. Clauss-fibrinogen methods. TEG®6S parameters obtained during rewarming were compared to the surrogate endpoints for perioperative bleeding using linear regression analysis. Among 100 patients, 225 TEG®5000 vs.TEG®6S comparisons and 54 TEG®6S-FLEV were analyzed. Good correlation was observed for all parameters comparing TEG®5000 to TEG®6S and TEG®6S-FLEV to the Clauss-fibrinogen method (Pearson r ≥ .7). Similar to rewarming TEG®5000 MA, rewarming TEG®6S MA was the only parameter independently associated with risk for perioperative bleeding (median [interquartile range {IQR}] in bleeding vs. nonbleeding patients: 35 [29, 48] vs. 37 [32, 55]; p = .02). A platelet transfusion calculator was developed based on TEG®6S results by determining the relationship between platelet transfusion volume (mL/kg) and percent change in MA using linear regression analysis. TEG®6S is a good alternative point-of-care method to analyze a patient's coagulation profile and it is comparable to TEG®5000 in pediatric patients undergoing cardiac surgery on cardiopulmonary bypass. Lower TEG®6S MA during rewarming is associated with increased risk for perioperative bleeding. TEG analysis during rewarming may be useful in customizing platelet transfusion therapy by reducing the risk of bleeding while minimizing excessive blood product transfusions.
