LAUSR

Coagulation testing needs to be performed before interventional procedures to assess a patient’s bleeding risk and the potential for replacement therapy prior to a procedure [1]; however, there is growing evidence that routine coagulation testing, such as prothrombin time/INR (PT/ INR) and partial thromboplastin time (PTT), may overestimate the risk of bleeding, potentially resulting in overtransfusion of blood products [2]. Therefore, there is a need to present a more accurate picture of hemostasis and bleeding risk. Thromboelastography (TEG) and rotational thromboelastography (ROTEM) are point of care tests that illustrate the viscoelastic changes that occur during clot formation, stabilization, and dissolution. TEG technology has evolved over time for use in clinical car areas such as cardiac surgery, trauma, solid organ transplant, critical care, and obstetrics. It is commonly described in the literature as a rapid, global coagulation test for bleeding patients to help guide appropriate transfusion therapy. Its adoption into management guidelines has resulted in decreased utilization of blood products with comparable, and in some cases, improved patient outcomes [3, 4]. The application of TEG in the setting of IR has not been previously described in the literature. Given the limitations of routine coagulation tests in identifying bleeding risk, TEG testing has the potential to provide a more accurate assessment of a patient’s risk for post-procedural bleeding. We have used this technique to support decision making in 3 consecutive patients who presented who were undergoing an interventional procedure and had mildly elevated coagulation markers. We relied on the TEG to guide us in our management of mild coagulopathy and as a result had no increased rate of bleeding or hematoma formation (Fig. 1). Patient 1 was a 7-year-old male who presented with a one-week history of diarrhea and acute onset of jaundice, subsequently found to be in acute liver failure. IR was consulted for liver biopsy. The pertinent laboratories were as follows: INR 1.7, PT 19.9, Platelets 236. Since the patient had elevated traditional coagulation markers, which would otherwise have precluded him from having a liver biopsy performed, a TEG was performed which showed normal coagulability. The liver biopsy was performed, and no bleeding complications were noted afterward. Patient 2 was a 13-year-old male with obesity and 3 week history of colicky right upper quadrant pain, vomiting, new onset jaundice, and scleral icterus. The patient was found to have multiple liver lesions and ascites on subsequent imaging. IR was consulted for liver biopsy. Relevant preprocedural laboratories: INR 1.6, PT 19.4, Platelets 402. Due to elevated traditional coagulation studies and ascites, both of which would preclude him from having a biopsy performed, a TEG was drawn and showed & Kevin Wong [email protected]