Does Thromboelastography Predict Postoperative Thromboembolic Events? A Systematic Review of the Literature
- 1 March 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Anesthesia & Analgesia
- Vol. 108 (3), 734-742
- https://doi.org/10.1213/ane.0b013e31818f8907
Abstract
Since thromboelastography (TEG) can detect hypercoagulable states, it is a potentially useful test for predicting postoperative thromboembolic complications. Therefore, we performed a systematic review of the literature to evaluate the accuracy of TEG in predicting postoperative thromboembolic events. PUBMED and EMBASE electronic databases were searched by two independent investigators to identify prospective studies involving adult patients undergoing operative procedures in which a TEG test was performed perioperatively and outcomes were measured by reference standards. The quality of included studies was assessed and measures of diagnostic test accuracy were estimated for each included study. Ten studies (with a total of 1056 patients) were included in this analysis; however, only five reported measures of TEG test accuracy. The overall quality of the studies and level of diagnostic evaluation of the studies were highly variable, from poor to good. As there were variations in the definition of hypercoagulability, TEG methodology and patient characteristics, reference standards used and outcomes measured, a meta-analysis was not undertaken. The sensitivity and specificity ranged from 0% to 100% and 62% to 92%, respectively. The diagnostic odds ratio ranged from 1.5 to 27.7; area under the curve ranged from 0.57 to 0.91. Of the TEG variables, maximum amplitude seems to be the best parameter to identify hypercoagulable states and to predict thromboembolic events. The predictive accuracy of TEG for postoperative thromboembolic events is highly variable. To determine if the TEG is a clinically useful screening test in high-risk surgical populations, more prospective studies are needed.Keywords
This publication has 45 references indexed in Scilit:
- Aprotinin Shows Both Hemostatic and Antithrombotic Effects During Off-Pump Coronary Artery Bypass GraftingThe Annals of Thoracic Surgery, 2006
- Whole blood thrombelastographic coagulation profiles using minimal tissue factor activation can display hypercoagulation in thrombosis‐prone patientsScandinavian Journal of Clinical and Laboratory Investigation, 2006
- Disruption of Graft Endothelium Correlates With Early Failure After Off-Pump Coronary Artery Bypass SurgeryThe Annals of Thoracic Surgery, 2005
- Hypercoagulable state associated with kidney–pancreas transplantation. Thromboelastogram‐directed anti‐coagulation and implications for future therapyClinical Transplantation, 2004
- Thromboelastogram monitoring in the perioperative period of hepatectomy for adult living liver donationLiver Transplantation, 2004
- Differences in perioperative coagulation between Japanese and other ethnic groups undergoing laparoscopic cholecystectomySurgical Endoscopy, 2003
- Thromboelastography for Monitoring Prolonged Hypercoagulability After Major Abdominal SurgeryAnesthesia & Analgesia, 2001
- Thrombelastographic evaluation of coagulation in transurethral prostatectomyBritish Journal of Urology, 1996
- Users' Guides to the Medical LiteratureJAMA, 1994
- Central nervous system complications of coronary artery bypass graft surgery: prospective analysis of 421 patients.Stroke, 1983