Ioscovich Alexander, Fadeev Dmitri, Kenet Gili, Naamad Mira, Schtrechman Gal, Zimran Ari, Elstein Deborah
Department of Anesthesiology, Perioperative Medicine & Pain Treatment, Shaare Zedek Medical Center, Jerusalem, Israel.
National Hemophilia Center, Sheba Medical Center, Tel Hashomer affiliated with the Sackler Medical School of the Tel Aviv University, Tel Aviv, Israel.
Clin Appl Thromb Hemost. 2016 Oct;22(7):693-7. doi: 10.1177/1076029615578165. Epub 2015 Mar 27.
Thromboelastography (TEG) has long been available for routine monitoring of perisurgical and postpartum hemostasis, especially at point of care. The purpose of this study is to retrospectively compare TEG parameters to concomitant standard clotting test results in an unselected cohort of patients with Gaucher disease to ascertain whether TEG values are specific and sensitive enough to substitute for classic coagulation tests for decision making. This remains a cogent concern because of high incidence of thrombocytopenia in patients with Gaucher disease. Thromboelastography values were compared to concomitant platelet counts, partial thromboplastin time, international normalization ratio, and plasma fibrinogen. Demographic characteristics were collected from patients' files. There were 22 patients with Gaucher disease (2 children; 12.5%) for whom there were 24 TEG results at the same time as classic coagulation test results and 30% performed platelet function tests. The current study shows linear and/or monotonic relationships between platelet counts and several TEG values that were significant over a range of platelet counts including severe thrombocytopenia. The fibrinogen component, correlating only with the rate of clot lysis, played a lesser role. Based on these preliminary results albeit in a small cohort with only 1 case of hemorrhage, there is putative support for the intention to treat patients with Gaucher disease based on TEG results using the same TEG protocol as for other patients undergoing comparable procedures in our institution.
