From the Guidelines
TEG is not recommended for diagnosing von Willebrand disease as it cannot assess the contribution of endothelium to coagulation and is insensitive to antiplatelet agents or platelet inhibition. The most recent and highest quality study, a systematic review of viscoelastic testing in obstetrics published in the Journal of Thrombosis and Haemostasis in 2020 1, highlights the limitations of TEG/ROTEM in detecting von Willebrand disease or other conditions affecting adherence to the endothelium.
Key Points to Consider
- TEG/ROTEM uses reagents that activate coagulation, bypassing primary hemostasis, making it insensitive to antiplatelet agents or any kind of platelet inhibition 1.
- The standard TEG is incapable of detecting platelet dysfunction, as demonstrated by Davies et al in severe preeclampsia 1.
- Newer versions of viscoelastic devices, such as TEG platelet mapping and ROTEM platelet system, may allow for the assessment of platelet function but still need to be validated 1.
- Traditional vWD tests like vWF antigen levels, ristocetin cofactor activity, and factor VIII levels are essential for comprehensive assessment and should be used instead of or in addition to TEG 1.
Clinical Implications
- Clinicians should exercise caution when interpreting TEG results in patients with suspected von Willebrand disease, as TEG may not accurately reflect the underlying coagulation disorder.
- A comprehensive diagnostic approach, including traditional vWD tests and clinical evaluation, is necessary for accurate diagnosis and management of von Willebrand disease.
From the Research
TEG for von Willebrand Disease
- Thromboelastography (TEG) is not directly mentioned in the provided studies as a treatment or diagnostic tool for von Willebrand disease (VWD).
- However, the management and treatment of VWD are discussed in the studies, including the use of desmopressin and von Willebrand factor-factor VIII concentrates 2, 3, 4, 5, 6.
- The studies suggest that the treatment of VWD depends on the severity of the disease, with desmopressin being the treatment of choice for type 1 VWD, and von Willebrand factor-factor VIII concentrates being used for more severe cases 2, 3, 4, 5, 6.
- The use of TEG in VWD is not explicitly mentioned, but it may be used as a diagnostic tool to assess the coagulation status of patients with VWD, as it is used in other coagulation disorders.
- Further research is needed to determine the role of TEG in the diagnosis and management of VWD, as the current evidence is limited to the treatment and management of the disease using desmopressin and von Willebrand factor-factor VIII concentrates 2, 3, 4, 5, 6.
Treatment Options
- Desmopressin is the treatment of choice for type 1 VWD, as it can induce the release of normal von Willebrand factor from cellular compartments 3, 6.
- Von Willebrand factor-factor VIII concentrates are used for more severe cases of VWD, including type 2 and type 3 2, 3, 4, 5.
- The choice of treatment depends on the severity of the disease, the type of surgery or procedure, and the patient's individual response to treatment 2, 3, 4, 5, 6.
Management Strategies
- Peri-operative management strategies for VWD patients depend on the VWD subtype, baseline von Willebrand factor and factor VIII levels, and the size of the procedure 2.
- Long-term prophylaxis with von Willebrand factor-factor VIII concentrates may be beneficial for some VWD patients, particularly those with severe disease 2, 5.
- Further research is needed to develop evidence-based guidelines for the management of VWD, including the use of TEG as a diagnostic tool 2, 3, 4, 5, 6.