Department of Surgery, St. Joseph Mercy Ann Arbor, Ann Arbor, MI, USA.
Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA.
Am Surg. 2023 Nov;89(11):4598-4603. doi: 10.1177/00031348221124327. Epub 2022 Aug 30.
Thomboelastography (TEG) is a point of care viscoelastic test that provides an assessment of clot formation and kinetics. Antiplatelet agents are commonly used but there is limited literature evaluating their possible effects on overall clot kinetics. We aimed to evaluate the relationship between antiplatelet agents and clot kinetics as defined by TEG.
This is a retrospective study of adult patients who underwent TEG from February 2018 to July 2020. Patients who received anticoagulants or blood transfusions within 72 hours, had an incomplete TEG, were diagnosed with COVID-19, or had liver failure were excluded. Patients were stratified based on antiplatelet status.
Of 1060 patients, 119 were included (50 controls, 69 antiplatelet agents-37 aspirin monotherapy, 26 dual antiplatelet therapy). Between the control and antiplatelet therapy groups, there was no significant difference in clot time, maximal clot strength, or fibrinogen level. When compared to control patients, patients on dual antiplatelets had significantly higher fibrinogen levels (408.1 mg/dL vs 481.5 mg/dL, = .013) but no significant differences in clot time or maximal clot strength. In our subgroup analysis, patients on dual antiplatelets had increased maximal clot strength (58.8° vs 63°, = .005) and fibrinogen levels (384.1 mg/dL vs 481.5 mg/dL, = .005) compared to those on aspirin alone.
Compared to control patients and those on aspirin alone, patients on dual antiplatelets have increased maximal clot strength and increased fibrinogen levels. These results can help physicians better target product resuscitation in patients who are on antiplatelet agents.
血栓弹力图（TEG）是一种即时检测的粘弹性测试，可评估凝血形成和动力学。抗血小板药物通常被使用，但评估其对整体凝血动力学可能影响的文献有限。我们旨在评估抗血小板药物与 TEG 定义的凝血动力学之间的关系。
这是一项回顾性研究，纳入了 2018 年 2 月至 2020 年 7 月间进行 TEG 的成年患者。排除在 72 小时内接受抗凝药物或输血、TEG 不完整、诊断为 COVID-19 或肝衰竭的患者。根据抗血小板状态对患者进行分层。
在 1060 名患者中，有 119 名患者符合入选标准（50 名对照组，69 名抗血小板药物治疗组-37 名阿司匹林单药治疗，26 名双联抗血小板治疗）。在对照组和抗血小板药物治疗组之间，凝血时间、最大凝块强度或纤维蛋白原水平无显著差异。与对照组患者相比，双联抗血小板治疗组患者的纤维蛋白原水平显著更高（408.1mg/dL 比 481.5mg/dL， =.013），但凝血时间或最大凝块强度无显著差异。在我们的亚组分析中，与单独使用阿司匹林相比，双联抗血小板治疗组患者的最大凝块强度（58.8°比 63°， =.005）和纤维蛋白原水平（384.1mg/dL 比 481.5mg/dL， =.005）更高。
与对照组患者和单独使用阿司匹林的患者相比，双联抗血小板治疗组患者的最大凝块强度和纤维蛋白原水平更高。这些结果可以帮助医生更好地针对使用抗血小板药物的患者进行产品复苏。
