Management of Elevated LY30 on Thromboelastography
Administer tranexamic acid (TXA) 1 gram IV over 10 minutes followed by 1 gram infusion over 8 hours immediately when LY30 is ≥3% on TEG, as this threshold predicts massive transfusion requirement and mortality in bleeding patients. 1, 2, 3
Understanding the Clinical Significance
LY30 ≥3% is the critical threshold for initiating antifibrinolytic therapy, as patients above this level face a 90.9% risk of massive transfusion versus 30.5% below this threshold, and a 45.5% mortality risk versus 4.8% below threshold 3
LY30 represents the percentage of clot degradation occurring 30 minutes after maximum amplitude, reflecting fibrinolytic activity in whole blood 2
For TEG 6s systems specifically, LY30 ≥10% carries particularly high clinical significance with a likelihood ratio of 8.22 for mortality, and patients are significantly more likely to require cryoprecipitate, transfusions, or massive transfusion protocol activation 4
The TEG 5000 and TEG 6s have different upper limits of normal (5.0% versus 3.2% respectively), and results are not interchangeable between devices 4
Immediate Treatment Protocol
Administer TXA 1 gram loading dose over 10 minutes followed by 1 gram infusion over 8 hours to inhibit plasminogen activation and reverse established fibrinolysis 1
Activate massive transfusion protocol immediately with 1:1:1 ratio of packed RBCs, FFP, and platelets when LY30 ≥3% 2
TXA is most effective when given within 3 hours of injury, with patients receiving TXA within 1 hour showing 65% lower likelihood of 30-day mortality 5
Repeat TEG 15-30 minutes after TXA administration to assess response to antifibrinolytic therapy 2
Alternative Antifibrinolytic Agent
Epsilon-aminocaproic acid (EACA) can be used as an alternative antifibrinolytic, though it should NOT be administered without definite laboratory finding indicative of hyperfibrinolysis 6
EACA inhibits both plasminogen activators and plasmin activity, but rapid IV administration should be avoided as it may induce hypotension, bradycardia, or arrhythmia 6
The concentration of EACA necessary to maintain inhibition of fibrinolysis is 0.99 mMol/L (0.13 mg/mL), achievable with a 5g bolus followed by 1-1.25 g/hr infusion 6
Critical Pitfalls to Avoid
Do not delay TXA administration while waiting for additional laboratory results in severe bleeding, as time-dependent efficacy is crucial 1
In postpartum hemorrhage, elevated kaolin TEG LY30 may reflect platelet-mediated clot retraction rather than true fibrinolysis - confirm with functional fibrinogen TEG which contains a platelet inhibitor before administering antifibrinolytics 7
TEG may be poorly sensitive to fibrinolysis in some cases (particularly traumatic brain injury), so integrate clinical assessment with laboratory findings rather than relying solely on TEG values 5
TXA is contraindicated in patients with subarachnoid hemorrhage due to increased risk of cerebral ischemia and vasospasm 1
Do not administer EACA with Factor IX Complex concentrates or Anti-Inhibitor Coagulant concentrates, as thrombosis risk increases 6
Standard coagulation tests (PT, aPTT) do not correlate well with clinical bleeding or TEG parameters and should not guide antifibrinolytic therapy decisions 1
Monitoring and Ongoing Management
Continue TEG monitoring to guide ongoing treatment, with goal of normalizing LY30 values 1
Goal-directed therapy using TEG parameters improves outcomes compared to conventional coagulation test-guided therapy in trauma patients 8
Consider higher fibrinogen targets (>2.0 g/L) if concurrent low maximum amplitude suggests fibrinogen deficiency contributing to coagulopathy 8