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LETTER TO THE EDITOR

TEG^TM and Perioperative Hypercoagulability

Department of Anesthesiology, University of Texas Medical School, Houston, TX, evan.g.pivalizza{at}uth.tmc.edu

To the Editor:

McCrath et al.'s recent investigation of the TEG® (Haemoscope, Niles, IL) as a sensitive detector of postoperative thrombotic complications is most interesting (1). TEG® analysis was performed 2 h postoperatively, presumably before any effect of postoperative antithrombotic prophylaxis.

1. The authors discount use of a baseline preoperative/intraoperative sample, although previous studies suggest that perioperative acceleration of coagulation is sequential. Earlier detection may facilitate appropriate intraoperative (e.g., subcutaneous heparin) or immediate postoperative (aspirin) thromboprophylaxis earlier in the course of developing hypercoagulability.

2. Do the authors have a hypothesis to explain the prolonged R time in the thrombotic group (Table 2 in the article) compared with the decreased R time in the MI group (Table 3 in the article)?

3. These data are important for anesthesiologists, as many surgical patients (60% in this study) are not receiving pharmacologic thromboprophylaxis, and we are in position to recommend and/or institute appropriate therapy in the intraoperative/immediate postoperative period.

We look forward to further data from the author's group, as evidence of platelet involvement suggests there may be a larger role for aspirin thromboprophylaxis (7% in the nonthrombotic, 0% in the thrombotic/myocardial infarction groups), although aspirin use did not alter maximum amplitude per se (Table 1 in the article). "Improving safety and efficacy of antithrombotic strategies..." may well include more liberal use!

Reference

1. McCrath DJ, Cerboni E, Frumento RJ, et al. Thromboelastography maximum amplitude predicts postoperative thrombotic complications including myocardial infarction. Anesth Analg 2005;100:1576–83.[Abstract/Free Full Text]

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