Flashcards in TEG- Exam 3 Deck (44):
1
What three processes are involved in hemostasis?
Activation
Clot formation
Clot lysis
2
Clot: Platelet-fibrin network
Platelets form plug
Clotting factors reinforce platelets
Fibrin acts as a glue
Clot strength
3
What is a clot composed of?
Platelets 80-90%
Fibrin 10-20%
4
What tests are available for component measurements?
PT/INR
PTT
Fibinogen concentration
Platelet Count
5
PT/INR Test
Measures extrinsic clotting (VIIa, Xa, IIa)
6
PTT
measures intrinsic clotting (XIIa, Xia, iXa, IIa)
7
Measurement of component interactions
TEG (shows the net effect "whole picture" of hemostasis
8
What is TEG?
A whole blood hemostasis analyzer
Point of care test
9
What is TEG?
A whole blood hemostasis analyzer
Point of care test
10
How does TEG work?
Cup oscillates
Pin is attached to torsion wire
Clot binds pin to cup
Degree and magnitude of pin motion are functions of the clot kinetics and mechanical properties
System generates a hemostasis profile
11
How does TEG work?
Cup oscillates
Pin is attached to torsion wire
Clot binds pin to cup
Degree and magnitude of pin motion are functions of the clot kinetics and mechanical properties
System generates a hemostasis profile
12
R
time of latency from the time that the blood was placed in the TEG analyzer until the initial fibrin formation
13
Alpha
The alpha value measures the rapidity (kinetics) of fibrin build-up and corss-linking, that is, the speed of clot strengthening
14
K
K time is a measure of the rapidity to reach a certain level of clot strength
15
MA
Max amplitude, direct function of the maximum dynamic properties of firbin and platelet bonding via GPIIb/IIIa and represents the ultimate strength of the fibrin clot
16
GI
coagulation index is linear combination of the above parameters
17
LY30
rate of amplitude reduction 30 minutes after MA. This measurement gives an indication of the stability of the clot
18
R
time of latency from the time that the blood was placed in the TEG analyzer until the initial fibrin formation; reaction time (time to clot formation)
19
Alpha
The alpha value measures the rapidity (kinetics) of fibrin build-up and cross-linking, that is, the speed of clot strengthening; speed of fibrin accumulation
20
K
K time is a measure of the rapidity to reach a certain level of clot strength; time elapsed until clot reaches a fixed strength
21
MA
Max amplitude, direct function of the maximum dynamic properties of firbin and platelet bonding via GPIIb/IIIa and represents the ultimate strength of the fibrin clot; highest vertical amplitude of TEG tracing
22
CI
coagulation index is linear combination of the above parameters
23
LY30
rate of amplitude reduction 30 minutes after MA. This measurement gives an indication of the stability of the clot; % of amplitude reduction 30 min after its max
24
LY30
rate of amplitude reduction 30 minutes after MA. This measurement gives an indication of the stability of the clot; % of amplitude reduction 30 min after its max
25
R Likely Variable
Coagulation Factors
26
Alpha Likely Variable
Fibrinogen
27
K LIkely Variable
Fibrinogen
28
MA Likely Variable
Platelets
29
Ly30 likely variable
Fibrinolysis
30
Ly30 likely variable
Fibrinolysis
31
TEG Assays
Standard (Kaolin)
Rapid TEG
Heparinase
Platelet Mapping
32
Standard (Kaolin)
Uses parameters listed above
33
Rapid TEG
uses tissue factor in place of kaolin to speed up the rxn
R-value is replaced by TEG-ACT value
Other parameters the same
34
Heparinase
Use on bypass or post bypass alongside a standard TEG
35
Platetlet Mapping
Determines to what degree platelet function is inhibited due to pharmacological inhibition of either the arachidonic acid (AA) or ADP pathways
AA: Aspirin
ADP: Clopidrogel
Run alongside a standard TEG and a TEG with added AA or ADP
Calculates platelet inhibition as a percentage
36
Platelet Mapping
Determines to what degree platelet function is inhibited due to pharmacological inhibition of either the arachidonic acid (AA) or ADP pathways
AA: Aspirin
ADP: Clopidrogel
Run alongside a standard TEG and a TEG with added AA or ADP
Calculates platelet inhibition as a percentage
37
Platelet Mapping
Determines to what degree platelet function is inhibited due to pharmacological inhibition of either the arachidonic acid (AA) or ADP pathways
AA: Aspirin
ADP: Clopidrogel
Run alongside a standard TEG and a TEG with added AA or ADP
Calculates platelet inhibition as a percentage
38
What does platelet mapping measure?
Measures the effect of antiplatelet agents on platelet function
Measures the patient's maximum platelet function as a reference point
Measures the percentage of inhibition relative to the patient's reference point
39
What does platelet mapping measure?
Measures the effect of antiplatelet agents on platelet function
Measures the patient's maximum platelet function as a reference point
Measures the percentage of inhibition relative to the patient's reference point
40
Platelet Mapping: What drugs are monitored?
Antiplatelet Drugs
-ADP receptor inhibitors
-Arachidonic acid pathway inhibitiors
-GPIIb/IIIa inihibitors
41
ADP receptor inhibitors
clopidogrel, ticlopidine
42
Arachidonic acid pathway inihibitors
aspirin
43
GPIIb/IIIa inhibitors
abciximab, tirofiban, eptifibatide
44