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. 2016 Oct;66(Suppl 1):340-6.
doi: 10.1007/s13224-016-0906-y. Epub 2016 Jun 22.

Role of Thromboelastography Versus Coagulation Screen as a Safety Predictor in Pre-eclampsia/Eclampsia Patients Undergoing Lower-Segment Caesarean Section in Regional Anaesthesia

Asrar Ahmad  1 , Monica Kohli  2 , Anita Malik  2 , Megha Kohli  3 , Jaishri Bogra  2 , Haider Abbas  2 , Rajni Gupta  2 , B B Kushwaha  2
Affiliations

Role of Thromboelastography Versus Coagulation Screen as a Safety Predictor in Pre-eclampsia/Eclampsia Patients Undergoing Lower-Segment Caesarean Section in Regional Anaesthesia

Asrar Ahmad et al. J Obstet Gynaecol India. 2016 Oct.

Abstract

Purpose: In this study, we aimed to correlate thromboelastography (TEG) variables versus conventional coagulation profile in all patients presenting with pre-eclampsia/eclampsia and to see whether TEG would be helpful for evaluating coagulation in parturients before regional anaesthesia.

Materials and methods: This was a prospective study on 100 pre-eclampsia/eclampsia patients undergoing lower-segment caesarean section under regional anaesthesia. Two blood samples were collected. First sample was used for TEG measurement and second sample for laboratory tests. The following TEG data were obtained-reaction time, kinetic time, alpha angle, and maximum amplitude (MA). The following laboratory tests were obtained-haematology (haemoglobin, TLC, DLC, platelet count) and coagulation test [prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time (TT)].

Result: Out of 100 patients enrolled in the study, 80 (80 %) had a normal coagulation profile, while remaining 20 (20 %) had hypocoagulation profile. The results show that TEG parameters have a good correlation with conventional coagulation profile and also showed excellent independent predictive efficacy for prediction of hypocoagulation. PT, aPTT, and TT were directly proportional to R-time and K-time and inversely proportional to alpha angle (p < 0.001). Platelet count showed a strong positive correlation with MA (p < 0.001).

Conclusion: By giving a global picture of haemostasis, TEG can lead to improved decision-making about safety of using regional anaesthesia. Its fast feedback time makes it ideal for monitoring in a fast moving situation such as in obstetric emergency.

Keywords: Coagulation; Regional anaesthesia; Thromboelastography.

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Conflict of interest statement

Dr. Monica Kohli, Dr. Anita Malik, Dr. Megha Kohli, Dr. Jaishri Bogra, Dr. Haider Abbas, Dr. Rajni Gupta, Dr. B. B. Kushwaha declare that they have no conflict of interest. Ethical Approval All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national).

Figures

Fig. 1
Fig. 1
Receiver operating characteristic (ROC) curve analysis for calculation of new cut-off values of TEG parameters (R-time and K-time) for prediction of hypocoagulation
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curve analysis for calculation of new cut-off values of TEG parameters (alpha angle and MA) for prediction of hypocoagulation
See this image and copyright information in PMC

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