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. 2025 May 17;11(1):27.
doi: 10.1186/s40981-025-00789-6.

Comprehensive evaluation of coagulability using thromboelastography in four patients with essential thrombocythemia

Shuji Kawamoto  1 , Tsuguhiro Matsumoto  2 , Yohei Chiwata  2 , Chikashi Takeda  2 , Eriko Kusudo  2 , Moritoki Egi  2
Affiliations

Comprehensive evaluation of coagulability using thromboelastography in four patients with essential thrombocythemia

Shuji Kawamoto et al. JA Clin Rep. .

Abstract

Background: Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by increased platelet count and risk of thrombosis and bleeding, which necessitates careful perioperative management. However, there are no standardized guidelines for perioperative antithrombotic therapy, and optimal preoperative evaluation remains unclear. In this report, we evaluate the utility of thromboelastography (TEG®6 s) for assessing coagulation and platelet function in ET patients undergoing surgery.

Case presentation: Four ET patients (platelet counts: 289,000-833,000/µL) underwent thromboelastography at anesthesia induction. Two had normal coagulation, while two had a hypercoagulable state undetected by conventional tests. Hypercoagulability was observed in patients who discontinued anticoagulants or antiplatelets preoperatively.

Conclusions: Thromboelastography identified thrombotic tendencies not evident with conventional coagulation tests, suggesting its potential for perioperative risk assessment in ET patients. This approach may improve individualized coagulation management beyond use of platelet counts and standard tests. Further studies are needed to establish the role of thromboelastography in optimizing perioperative antithrombotic strategies.

Keywords: Coagulation; Essential thrombocythemia; Platelet; Thromboelastography.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This work was conducted in the Department of Anesthesia, Kyoto University Hospital, with the approval of the Ethics Committee of Kyoto University Hospital (No. R4875). The work was carried out according to the guidelines of the Declaration of Helsinki. Consent for publication: Written consent was obtained from all the patients for publication of this case series. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
TEG®6 s Global Hemostasis and PlateletMapping® results. A. Case 1, B. Case 2, C. Case 3, D. Case 4. Highlighted areas indicate abnormal values. The normal range of each parameter is shown at the bottom of the values. CK: citrate kaolin, CRT: citrated rapid TEG, CKH: citrate kaolin with heparinase, CFF: citrated functional fibrinogen, ActF: activator F, HKH: heparinized kaolin with heparinase, ADP: adenosine diphosphate. Shortened reaction time (R) and clot formation time (K), along with increased alpha angle (angle) and maximum amplitude (MA), are indicative of a hypercoagulable state. In this figure, Cases 2 and 3 show such hypercoagulable profiles, whereas Cases 1 and 4 exhibit values within the normal range, suggesting balanced coagulation
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