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Thromboelastography: Where Is It and Where Is It Heading?

Thromboelastography (TEG) has been in existence since 1948. However, it is only recently that it has made great strides into the clinical practice arena, where it is being used to assist in the diagnosis and management of coagulation problems during liver transplantation and cardiac surgery and in obstetrics. With the advent of computerization in the last decade, TEG has evolved from a research laboratory tool into a compact, user-friendly process, providing global information on the entire coagulation process. In fact, TEG is the only single test method that provides information on the balance between two important and opposing components of coagulation, namely thrombosis and lysis. The battery of traditional coagulation tests, which include bleeding time, prothrombin time (PT), partial thromboplastin time (PTT), thrombin time, fibrinogen and factor assays, and platelet function studies, are based on the isolated, static end points of standard laboratory tests. They do not take into account the interaction of clotting cascade and platelets in the whole blood. Furthermore, some of these tests can be nonspecific. For example, bleeding time has been shown to be a nonspecific indicator of platelet function. Platelet aggregation tests are expensive, laborious, and difficult to reproduce, and abnormalities cannot be used to predict risk of hemorrhage. The tests that measure clot lysis, which include fibrinogen degradation products, can be elevated in renal and hepatic disease. In contrast, hemostasis is an integrated, interactive, dynamic, and extremely complex process involving coagulation proteins, activators, cellular elements, and inhibitors. TEG measures this interactive dynamic coagulation process from the initial clotting cascade to platelet interaction and clot strengthening (via