Role of Thrombelastography (TEG) in Risk Assessment and Guidance of Antithrombotic Therapy in Patients with Coronary Artery Disease

Authors

  • Abbas Bitar,

    1. Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
    Search for more papers by this author
  • Rolf P. Kreutz

    Corresponding author
    1. Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
    • Correspondence to: Rolf P. Kreutz, Krannert Institute of Cardiology, & Division of Clinical Pharmacology, Indiana University School of Medicine, 1800 N. Capitol Ave, MPC2, ME-400, Indianapolis, IN 46202, USA.

      E-mail: rkreutz@iu.edu

    Search for more papers by this author

ABSTRACT

Clinical Development Phases I-III Regulatory, Quality, Manufacturing

Thrombelastography (TEG) is a viscoelastic assay method used to assess whole blood and plasma coagulation kinetics. Specialized platelet mapping assays have been developed for the TEG platform to quantify the extent of platelet inhibition derived from P2Y12 receptor inhibitors, glycoprotein IIb/IIIa inhibitors, and aspirin. In this review, we describe the current evidence and summarize the data supporting the use of TEG in patients with cardiovascular disease. High thrombin- or adenosine diphosphate (ADP)-induced whole blood maximal clot strength (MA) has been associated with increased risk of ischemic events after percutaneous coronary interventions (PCI) and coronary artery bypass grafting (CABG). We discuss the data linking an increased clot strength phenotype with changes in metabolic and inflammatory markers. In addition, the data supporting the role of TEG in identifying subjects at risk for hemorrhagic complications while treated with dual antiplatelet therapy or while undergoing cardiac surgery is reviewed. In summary, TEG may provide additional information combining coagulation and platelet measurements within one assay, as compared with traditional coagulation or platelet assays. Further research is warranted to establish the role of TEG in personalized medicine treatment protocols.

Ancillary