Gaspari Rita, Aceto Paola, Carelli Simone, Avolio Alfonso Wolfango, Bocci Maria Grazia, Postorino Stefania, Spinazzola Giorgia, Caporale Mariagiovanna, Giuliante Felice, Antonelli Massimo
Department of Basic Biotechnological Sciences, Intensive Care Peri-Operative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
J Clin Med. 2025 Apr 22;14(9):2866. doi: 10.3390/jcm14092866.
: Thromboelastography-6s (TEG6s), a novel device developed to assess coagulation status, presents advantages such as less frequent calibration, ease of use, and greater stability against movements compared to the previous system (TEG5000). This is the first study in the literature to compare coagulation profiles in the early postoperative period of liver resection (LR) using conventional coagulation tests (CCTs) and TEG6s. : Forty-six adult patients admitted to the ICU post-surgery after elective LR for malignancy were included. CCTs were used to classify patients into hypocoagulable (HCG) (platelet count < 80 × 10/L, international normalized ratio ≥ 1.4, or activated partial thromboplastin time > 38 s) and normocoagulable (all other cases) groups. Mann-Whitney tests, Spearman's correlation, and linear regression were used. : On ICU admission, nineteen (41.3%) patients had a hypocoagulable profile based on CCTs, but only two (10.5%) of them were rated as hypocoagulable by TEG ( = 0.165). Intraoperatively, HCG patients experienced higher estimated blood loss (EBL) ( = 0.002); they required more fluids ( = 0.019), and more of them received red blood cell transfusions ( = 0.025). They also had higher postoperative arterial lactate levels ( = 0.036). Postoperative 12 h EBL was similar in the two groups (around 150 mL). The ICU stay was longer for HCG group ( = 0.010). Weak associations were observed between TEG/CCTs measures of coagulation initiation [e.g., between R time citrated rapid TEG, and international normalized ratio (r = 0.448; < 0.001)], clot formation [i.e., between conventional fibrinogen value using Clauss method and α-angle citrated rapid TEG (r = 0.542; < 0.001)], and clot strength [e.g., between conventional fibrinogen and citrated kaolin maximum amplitude (r = 0.484; < 0.001)]. : CCTs revealed hypocoagulability that was not confirmed by TEG6s. However, the thromboelastography coagulation profile was more consistent with the detected non-relevant postoperative bleeding.
血栓弹力图-6s（TEG6s）是一种用于评估凝血状态的新型设备，与之前的系统（TEG5000）相比，它具有校准频率较低、使用方便以及对运动稳定性更强等优点。这是文献中第一项比较使用传统凝血试验（CCT）和TEG6s评估肝切除（LR）术后早期凝血情况的研究。纳入了46例因恶性肿瘤接受择期LR手术后入住重症监护病房（ICU）的成年患者。使用CCT将患者分为低凝（HCG）组（血小板计数<80×10⁹/L、国际标准化比值≥1.4或活化部分凝血活酶时间>38秒）和正常凝血组（其他所有病例）。采用曼-惠特尼检验、斯皮尔曼相关性分析和线性回归分析。在入住ICU时，根据CCT有19例（41.3%）患者呈低凝状态，但其中只有2例（10.5%）被TEG评定为低凝（P = 0.165）。术中，HCG组患者估计失血量（EBL）更高（P = 0.002）；他们需要更多的液体（P = 0.019），并且更多患者接受红细胞输血（P = 0.025）。他们术后动脉血乳酸水平也更高（P = 0.036）。两组术后12小时EBL相似（约150毫升）。HCG组在ICU的停留时间更长（P = 0.010）。在凝血启动的TEG/CCT测量值之间观察到弱相关性[例如，在枸橼酸快速TEG的R时间与国际标准化比值之间（r = 0.448；P<0.001）]、血栓形成[即，在使用克劳斯方法的传统纤维蛋白原值与枸橼酸快速TEG的α角之间（r = 0.542；P<0.001）]以及血栓强度[例如，在传统纤维蛋白原与枸橼酸高岭土最大振幅之间（r = 0.484；P<0.001）]。CCT显示的低凝状态未得到TEG6s的证实。然而，血栓弹力图凝血情况与检测到的术后非相关性出血更一致。
