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. 2023 Apr 24;15(4):e38044.
doi: 10.7759/cureus.38044. eCollection 2023 Apr.

Validity and Utility of Early Parameters in TEG6s Platelet Mapping to Assess the Coagulation Status During Cardiovascular Surgery With Cardiopulmonary Bypass

Yusuke Yoshikawa  1 , Makishi Maeda  1 , Sho Ohno  1 , Kanako Takahashi  1 , Yasuaki Sawashita  1 , Tomoki Hirahata  1 , Yutaka Iba  2 , Nobuyoshi Kawaharada  2 , Mitsutaka Edanaga  1 , Michiaki Yamakage  1
Affiliations

Validity and Utility of Early Parameters in TEG6s Platelet Mapping to Assess the Coagulation Status During Cardiovascular Surgery With Cardiopulmonary Bypass

Yusuke Yoshikawa et al. Cureus. .

Abstract

Background The aim of this retrospective observational study was to explore the early predictive parameters for maximum amplitudein the kaolin with heparinase (HKH) assay (MAHKH) of TEG6s Platelet Mapping in cardiovascular surgery including cardiopulmonary bypass (CPB) period. The relationship between each parameter of the assay and laboratory data was also assessed. Methods We included the patients who underwent TEG6s Platelet Mapping during cardiovascular surgery under CPB between November 2021 and May 2022. The correlation between MAHKH and the early parameters was assessed. The association between each parameter of Platelet Mapping and a combination of fibrinogen concentration > 150 mg/dL and platelet count > 100,000µL was also evaluated by the receiver operating characteristic (ROC) curve. Results In 23 patients who underwent TEG6s Platelet Mapping during the study period, 62 HKH assay data including 59 pairs of data (HKH assay and laboratory data) were analyzed. K and angle, but not R, were significantly correlated with MAHKH (r [95% CI]: -0.90 [-0.94, -0.83], p < 0.0001 for K, and 0.87 [0.79, 0.92], p < 0.0001 for angle). Furthermore, ROC curves suggested that these parameters predicted a combination of fibrinogen concentration > 150 mg/dL and platelet count > 100,000/µL with high accuracy. Similar results were confirmed in the heparinized blood samples obtained during CPB. Conclusion These findings suggest that not only MAKHK but also K and angle, which are early parameters in the HKH assay, provide clinically significant information that will facilitate rapid decision-making regarding coagulation strategies during cardiovascular surgery including the CPB period.

Keywords: cardiac surgery; cardiopulmonary bypass; coagulation; platelet mapping; teg6s.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Scheme of HKH and ActF assays in TEG6s Platelet Mapping
Figure 2
Figure 2. Correlation between MAHKH and early parameters in the HKH assay of TEG6s platelet mapping
The figure shows Spearman’s rank correlation coefficient (r) expressed with a 95% CI. (a) All samples. (b) Heparinized blood samples obtained during CPB.
Figure 3
Figure 3. Correlation between fibrinogen concentration and each parameter in the HKH assay
The figure shows Spearman’s rank correlation coefficient (r) expressed with a 95% CI. (a) All samples. (b) Heparinized blood samples obtained during CPB. FBG, fibrinogen.
Figure 4
Figure 4. Correlation between platelet count and each parameter in the HKH assay
The figure shows Spearman’s rank correlation coefficient (r) expressed with a 95% CI. (a) All samples. (b) Heparinized blood samples obtained during CPB. PLT, platelet.
Figure 5
Figure 5. ROC curves of each parameter in HKH assay for combination of fibrinogen concentration > 150 mg/dL and platelet count > 100,000/µL
AUCs are expressed with a 95% CI in the figure. (a) All samples. (b) Heparinized blood samples obtained during CPB. The cut-off value (specificity, sensitivity) is expressed in the figure.
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