Abstract Number: PB0507
Meeting: ISTH 2020 Congress
Background: Quantitative diagnosis of the fibrinolysis is not so well developed and not routinely practiced as compared to the coagulation system.
Aims: This study aimed to assess the utility of thromboelastogram (TEG® 5000) and Thrombin Generation Assay (TGA) by TEG in diagnosing and categorizing the fibrinolysis activity.
Methods: All Citrated Kaolin TEG done during study period were classified into primary fibrinolysis (group1), secondary (group 2) and without fibrinolysis (group 3) based on TEG algorithm. Clinical management were decided upon TEG and clinical outcome were compared to understand the utility of TEG and TGA. Parameters analysed were TEG, TGA, blood transfusions, antifibrinolytics, anticoagulants, length of hospital stay and complications.
Results: A total of 436 patients included with a male to female ratio of 2.17 and a mean age of 43.64 (SD18.67). Common indications were trauma, CLD, DIC, Sepsis and Post partum hemorrhage. Fibrinolysis was observed in 192 (44.03%) patients, of these 59.3 % was primary, 40.6% was secondary and remaining were group 3 (n=244). Antifibrinolytic was given in 62.5% of primary fibrinolysis. Transfusion was avoided in sepsis induced coagulopathy (n=11, 46.3%) even with prolonged PT or aPTT and started on heparin. Both TEG and TGA had a positive correlation with fibrinolysis (r=0.662, P< 0.0001) All parameters except angle was significantly associated with fibrinolysis categories (P < 0.001 by multiway ANOVA). Among TEG and TGA parameters, G, Ly 30 and Total lysis had significant association for fibrinolysis categories (Beta of -0.438, -0.331, -0.196 respectively, P< 0.002). ROC curve showed Ly30 and L (AUC = 0.989, 0.946) differentiated presence of fibrinolysis meanwhile CI and TG were significantly differentiated primary and secondary (AUC=0.992, 0.951).
Conclusions: Differentiating primary & secondary fibrinolysis may not be possible with routine investigations and since management of both the conditions are different, incorporating TEG into the decision algorithm will improve the patient care.
To cite this abstract in AMA style:Mohan G, Shastry S, Prethika PA, Kandasamy D. Diagnosing and Categorizing Acquired Fibrinolysis Activity with Global Hemostatic Assays [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/diagnosing-and-categorizing-acquired-fibrinolysis-activity-with-global-hemostatic-assays/. Accessed October 1, 2023.
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