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CARDIOVASCULAR ANESTHESIA

Arterial and Venous Thrombelastograph^® Variables Differ During Cardiac Surgery

Heather E. Manspeizer, MD^*, Mayuko Imai, MD^*, Robert J. Frumento, MS, MPH^*, Michael K. Parides, PhD, Berend Mets, MBChB, PhD, FRCA, FFASA^*, and Elliott Bennett-Guerrero, MD^*

Departments of *Anesthesiology and Biostatistics, Columbia University College of Physicians & Surgeons, New York, New York

Address correspondence to Elliott Bennett-Guerrero, MD, Department of Anesthesiology, Columbia University College of Physicians & Surgeons, 630 W. 168th St. (PH5-505), New York, NY 10032-3784. Address e-mail to eb413{at}columbia.edu

The Thrombelastograph^® (TEG^®; Haemoscope Corp., Skokie, IL) coagulation analyzer is an effective point-of-care monitor for routine clinical practice and clinical research. Prior investigators have used either arterial or venous samples of blood for TEG^® measurements. We conducted this prospective cohort study to determine potential differences in TEG^® variables between arterial and venous blood samples. Arterial and venous samples were drawn from 40 cardiac surgical patients, yielding 134 pairs for comparison. Twenty-nine comparisons (control) were between arterial and arterial samples and were not significantly different. For the arterial and venous comparisons (n = 105), mean (±sd) arterial and venous values were the following: reaction time, 10 ± 2 mm vs 13 ± 4 mm, P = 0.004; maximum amplitude, 59 ± 9 mm vs 49 ± 12 mm, P < 0.001; angle, 61 ± 10 degrees vs 51 ± 14 degrees, P < 0.001; K, 5 ± 2 mm vs 8 ± 4 mm, P = 0.007; and lysis, 2.5 ± 1.7 vs 2.5 ± 2.0 (not significant), arterial versus venous, respectively. Arterial blood samples demonstrated TEG^® values reflecting stronger (larger maximum amplitude) and faster (shorter reaction time and K value, wider angle) clot formation. The results suggest that users of TEG^® coagulation analyzers should be consistent with the site of blood sampling given the potential differences obtained.

IMPLICATIONS: Thrombelastograph^® (TEG^®) values obtained from venous blood samples differ from values obtained from arterial blood samples. When the TEG^® coagulation analyzer is used for clinical purposes, it is important to be consistent in the blood collection site.

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