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Thromboelastography (TEG) is a laboratory test that measures the time to a clot starts to form, the rate at which the clot forms, the time it takes the clot to become 20 mm, the maximum amplitude the clot forms, and the amount of clot lysed at 30 minutes. This test is highly effective at determining...

Thromboelastography (TEG) is a laboratory test that measures the time to a clot starts to form, the rate at which the clot forms, the time it takes the clot to become 20 mm, the maximum amplitude the clot forms, and the amount of clot lysed at 30 minutes. This test is highly effective at determining the appropriate treatment for coagulopathy because it is a dynamic test that tests multiple components of the coagulation cascade as opposed to prothrombin time (PT), which only measures factors I, II, V, VII, and X, or partial thromboplastin time (PTT), which only measures factors I, II, V, VIII, IX, X, XI, and XII. This patient has an extended R time, K time, and alpha angle, which means he is deficient in coagulation factors and fibrinogen. Therefore, he should be treated with fresh frozen plasma (FFP) to increase his amount of coagulation factors and cryoprecipitate to increase his amount of fibrinogen. TEG Parameters Name Meaning Problem Treatmen t R time Time until clot starts forming (related to clotting cascade) If extended, there is an issue with coagulation factors FFP K time Time until clot reaches amplitude of 20 mm (related to the function of fibrinogen, factor IIa, and platelets) If extended, fibrinogen is forming clot slowly Cryopreci pitate Alpha angle The angle of slope between R time and K time (related to the function of fibrinogen, factor IIa, and platelets) If shallow, fibrinogen is forming clot slowly Cryopreci pitate Maximum amplitude (MA) High amplitude clot achieves (related to function of platelets (80%) and fibrinogen (20%)) If low, clot is small and weak Platelets Lysis at 30 minutes (LY30) Amount of clot lysed at 30 minutes (related to level of fibrinolysis) If high, clot is being lysed too much Tranexam ic acid/ aminocap roic acid TEG Parameters Name Meaning Problem Treatmen t R time Time until clot starts forming (related to clotting cascade) If extended, there is an issue with coagulation factors FFP K time Time until clot reaches amplitude of 20 mm (related to the function of fibrinogen, factor IIa, and platelets) If extended, fibrinogen is forming clot slowly Cryopreci pitate Alpha angle The angle of slope between R time and K time (related to the function of fibrinogen, factor IIa, and platelets) If shallow, fibrinogen is forming clot slowly Cryopreci pitate Maximum amplitude (MA) High amplitude clot achieves (related to function of platelets (80%) and fibrinogen (20%)) If low, clot is small and weak Platelets Lysis at 30 minutes (LY30) Amount of clot lysed at 30 minutes (related to level of fibrinolysis) If high, clot is being lysed too much Tranexam ic acid/ aminocap roic acid