Haemonetics Corp., Boston, Massachusetts.
Faculty of Medicine, University of Southampton & Cardiothoracic Department, University Hospital Southampton, United Kingdom.
Semin Thromb Hemost. 2023 Mar;49(2):192-200. doi: 10.1055/s-0042-1757545. Epub 2022 Oct 17.
Viscoelastic testing (VET), such as thromboelastography, can measure whole blood coagulation dynamics in real time and is used across a range of clinical settings, including cardiac surgery, liver transplant, and trauma. The use of modified thromboelastography with platelet function assessment (TEG(R) PlateletMapping(R) Assay) can provide an analysis of platelet contribution to hemostasis, including the contribution of the P2Y12 receptor and thromboxane pathway to platelet function. The TEG PlateletMapping Assay has shown high correlation with the current gold standard test of platelet function, light transmission aggregometry, to measure arachidonic acid and adenosine diphosphate agonist-induced platelet activation. Studies have also shown comparable results with other whole blood platelet function tests. In this review, we explore the clinical applications of modified thromboelastography with platelet function assessment. This includes guiding dual antiplatelet therapy in relation to cardiac procedures, such as percutaneous coronary interventions, transcatheter aortic valve replacement, and left atrial appendage closure. We also explore the developing use of thromboelastography in the emergency care setting of coronavirus disease 2019, which is commonly associated with a hypercoagulable and hypofibrinolytic state. Despite a general lack of high-quality, grade 1 evidence regarding the use of modified thromboelastography with platelet function assessment in these disease areas, the ability of the TEG PlateletMapping Assay to measure global hemostasis and platelet reactivity rapidly and to view and evaluate results at the point of care makes it a promising area for further study for managing patient treatment and optimizing hemostatic therapy.
黏弹性测试（VET），如血栓弹力图，可实时测量全血凝血动力学，应用于多种临床环境，包括心脏手术、肝移植和创伤。使用改良的血栓弹力图联合血小板功能评估（TEG® PlateletMapping® Assay）可以分析血小板对止血的贡献，包括 P2Y12 受体和血栓素途径对血小板功能的贡献。TEG PlateletMapping Assay 与血小板功能的当前金标准测试——光密度比浊法高度相关，可测量花生四烯酸和二磷酸腺苷诱导的血小板激活。研究还表明，该检测与其他全血血小板功能检测具有可比性的结果。在这篇综述中，我们探讨了改良的血栓弹力图联合血小板功能评估的临床应用。这包括指导与心脏手术（如经皮冠状动脉介入治疗、经导管主动脉瓣置换术和左心耳封堵术）相关的双联抗血小板治疗。我们还探讨了血栓弹力图在 2019 年冠状病毒病（COVID-19）急救环境中的应用。COVID-19 通常与高凝状态和低纤维蛋白溶解状态相关。尽管关于在这些疾病领域使用改良的血栓弹力图联合血小板功能评估的证据总体缺乏高质量的 1 级证据，但 TEG PlateletMapping Assay 能够快速测量整体止血和血小板反应性，并在床边查看和评估结果，这使其成为管理患者治疗和优化止血治疗的进一步研究的一个有前途的领域。
