Thromboelastography as a novel viscoelastic method for hemostasis monitoring: Its methodology, applications, and constraints

Thromboelastography (TEG) is a novel viscoelastic method which provides a comprehensive assessment of hemostasis from clot initiation and development to fibrinolysis involving both cellular and plasmatic components of hemostatic system. Apart from surgery its role is expanding into medical specialties with increasing integration into laboratory settings. TEG complements the conventional coagulation tests in assessment of bleeding disorders. Further hemotherapy based on TEG results has been shown to reduce transfusion requirements in varied clinical settings besides helping in identifying coagulopathies in patients with major bleedings. This review article addresses briefly the methodology, clinical applications, interpretation of TEG results including authors' own experience of TEG in different clinical scenarios and limitations of TEG. Overall, this technique seems to be helpful for evaluation of hypercoagulable state and in detecting fibrinolysis which are difficult to be detected with conventional coagulation tests. Kaolin activated citrated blood samples analyzed within 30-60 min of sampling can provide reliable results in a laboratory setting. However, multiple assays using different activators or modifiers may be required for accurate results in selected cases. The operator should be aware about the various preanalytical and analytical variables which can affect the results including limitations of this technique. The tracing of the thromboelastography should be interpreted cautiously taking into consideration the clinical picture of the patient and results of other laboratory tests. With improved model and availability of more assays it is hoped that TEG and other such hemostasis analyzers would bring in the paradigm shift in the hemostasis monitoring and treatment of patients in future.