What does a high LY30 value on a Thromboelastography (TEG) report indicate?

High LY30 on TEG Indicates Hyperfibrinolysis

A high LY30 value on TEG indicates hyperfibrinolysis—excessive breakdown of the blood clot after it has formed—which is associated with increased risk of massive transfusion and mortality. 1

What LY30 Measures

• LY30 represents the percentage of clot degradation occurring 30 minutes after reaching maximum amplitude (MA), reflecting the fibrinolytic activity in whole blood 1
• The measurement captures clot breakdown that occurs after the clot has achieved its maximum strength, providing real-time assessment of fibrinolysis 1

Defining "High" LY30: Critical Thresholds

Trauma and Acute Hemorrhage

• LY30 ≥3% defines clinically relevant hyperfibrinolysis and strongly predicts massive transfusion requirement and increased mortality in trauma patients with uncontrolled hemorrhage 2
• LY30 values between 3-7.5% represent moderate hyperfibrinolysis with significantly elevated risk 1
• LY30 >7.7% on rapid TEG (rTEG) represents severe hyperfibrinolysis based on optimal prediction of massive transfusion 3
• The "death diamond" pattern—complete clot lysis before the LY30 measurement point with time to MA ≤14 minutes—carries 100% positive predictive value for mortality 4

Device-Specific Considerations

• TEG 6s has a lower upper limit of normal (3.2%) compared to TEG 5000 (5.0%), making direct comparison between devices problematic 5
• TEG 6s demonstrates superior mortality prediction at LY30 ≥10%, with a likelihood ratio of 8.22 for death 5
• Results are not interchangeable between TEG and ROTEM devices 6

Clinical Significance and Mortality Risk

• Patients with LY30 ≥3% have a 90.9% rate of requiring massive transfusion versus 30.5% in those with LY30 <3% (p=0.0008) 2
• Mortality from hemorrhage is 45.5% in patients with LY30 ≥3% versus 4.8% in those with LY30 <3% (p=0.0014) 2
• A U-shaped distribution exists: both hyperfibrinolysis (high LY30) and fibrinolysis shutdown (very low LY30 <0.6%) are associated with increased mortality 3

Special Population: Obstetrics

Important Caveat in Postpartum Hemorrhage

• In postpartum hemorrhage, elevated kaolin TEG LY30 values may reflect platelet-mediated clot retraction rather than true fibrinolysis 7
• In one obstetric study, 12.7% of patients had kaolin TEG LY30 ≥3%, but none demonstrated fibrinolysis when assessed with functional fibrinogen TEG (which contains platelet inhibitor) 7
• Functional fibrinogen TEG should be used to distinguish true fibrinolysis from clot retraction in obstetric patients 7

Antiphospholipid Syndrome

• Patients with antiphospholipid syndrome (APS) or persistent antiphospholipid antibodies demonstrate significantly increased LY30 compared to controls, reflecting enhanced fibrinolysis 1

Immediate Management Algorithm

When LY30 ≥3%

1. Activate massive transfusion protocol immediately with 1:1:1 ratio of packed RBCs, FFP, and platelets 8
2. Administer tranexamic acid (TXA) 1g IV over 10 minutes, followed by 1g infusion over 8 hours 8
3. Target fibrinogen >200 mg/dL using cryoprecipitate (10 units) or fibrinogen concentrate (4g/70kg) 8

When LY30 ≥10% (TEG 6s)

• Patients are significantly more likely to die, require cryoprecipitate, receive transfusions, or require massive transfusion protocol 5
• Aggressive antifibrinolytic therapy with TXA is life-saving 8

"Death Diamond" Pattern

• Complete clot lysis before LY30 measurement with time to MA ≤14 minutes carries 100% mortality 4
• This pattern may represent an objective criterion to reconsider continuation of hemostatic resuscitation efforts 4

Monitoring Response

• Repeat TEG 15-30 minutes after any intervention to assess response to antifibrinolytic therapy 6
• Target normalization of LY30 to <3% 2

Critical Pitfalls to Avoid

• Do not assume elevated LY30 always represents fibrinolysis in obstetric patients—use functional fibrinogen TEG to confirm true fibrinolysis versus platelet-mediated clot retraction 7
• Do not compare LY30 values between TEG 5000 and TEG 6s devices directly—they have different upper limits of normal and clinical thresholds 5
• TEG shows high coefficients of variance (7.1-39.9%), requiring interpretation in clinical context 6
• The previously accepted "normal" upper bound of 7.5% LY30 is inappropriate in severe trauma, as mortality risk rises at much lower levels 2