From the Guidelines
Thromboelastography (TEG) is indicated in clinical scenarios requiring rapid assessment of coagulation status, particularly in acute bleeding situations or before procedures with high bleeding risk, such as liver transplantation, cardiac surgery, trauma management, obstetric hemorrhage, and complex coagulopathies. TEG provides real-time evaluation of clot formation, strength, and dissolution, offering advantages over conventional coagulation tests. Specific indications include:
- Guiding blood product transfusion during massive hemorrhage
- Monitoring anticoagulation therapy
- Assessing platelet function
- Evaluating hyperfibrinolysis
- Managing coagulopathy in critically ill patients TEG helps clinicians make targeted interventions by identifying specific hemostatic defects - whether related to clotting factors, platelets, or fibrinolysis. This targeted approach allows for more precise blood product administration (platelets, cryoprecipitate, fresh frozen plasma) and hemostatic agents (tranexamic acid, fibrinogen concentrate) based on the actual coagulation abnormality rather than empiric therapy, potentially reducing unnecessary transfusions and associated complications 1. In patients with cirrhosis, TEG may be useful in guiding blood product transfusions and reducing the risk of bleeding complications, although the evidence is still limited and more studies are needed to fully establish its role in this setting 1. In trauma patients, TEG can be used to rapidly assess coagulation status and guide transfusion therapy, particularly in patients on anticoagulant therapy 1. In obstetric patients, TEG may be useful in guiding transfusion therapy for postpartum hemorrhage and in assessing the risk of thrombosis and hemorrhage, although more studies are needed to fully establish its role in this setting 1.
From the Research
Indications for TEG
TEG (Thromboelastography) is indicated in various clinical settings, including:
- Elective cardiac and liver surgery 2
- Emergency resuscitation 2
- Trauma-induced coagulopathy 3
- Liver transplant patients 4
- Severely injured patients with elevated fibrin degradation products and low fibrinolytic activity 5
Clinical Settings
TEG is useful in the following clinical settings:
- Perioperative bleeding management 2, 6, 4
- Coagulopathy diagnosis and management 3, 6, 4
- Transfusion management 2, 6, 4
- Patient outcomes improvement, including reduction of bleed rate, length of stay, and mortality 2, 6
Patient Populations
TEG is indicated in various patient populations, including: