Thrombelastograph® Haemostasis
Analyser (TEG 5000®)
Haemostasis issues for Clinicians
 Identify Haemostatic Imbalance
 Before Surgery
 Prothrombotic
 Platelet Function
 Excess Fibrinolysis
 During Surgery
 Platelet Function
 Excess Fibrinolysis
 Factor deficiency vs residual circulating anti-coagulant
 After Surgery (If the patient is bleeding how it should be
treated)
 Coagulopathy
 Excess anti-coagulant
 Surgical
Copyright © 2009 Haemonetics Corp.
Thrombelastograph® Haemostasis Analyser
(TEG®)
 Near Patient Monitor
 Laboratory
 Whole Blood Analyser
 Visco elastic properties
 2 channel system
 Complete picture
 Easy to operate
Copyright © 2009 Haemonetics Corp.
TEG® Technology
Copyright © 2009 Haemonetics Corp.
TEG® 5000
Thrombelastograph® Hemostasis System
 The most comprehensive hemostasis analyzer that can guide
clinicians to improve patient outcomes
 Reduce allogeneic blood component use:
 Red Blood Cells
 Platelets
 Fresh Frozen Plasma
 Predict thrombotic complications
 Myocardial Infarction (MI)
 Ischemic Stroke
 Deep Vein Thrombosis (DVT)
 Pulmonary Embolism (PE)
Copyright © 2009 Haemonetics Corp.
The TEG® System helps you keep
hemostasis in balance
 How often are platelets or fresh frozen plasma (FFP) transfused without a
complete picture of the patient’s coagulation status?
 What’s the cost to treat an infection caused by an avoidable allogeneic
transfusion?
 How often is the patient at risk for thrombosis?
Copyright © 2009 Haemonetics Corp.
A new standard of care
 The TEG® 5000 Hemostasis Analyzer System provides a more complete
picture of patients’ hemostasis, thus helping you deliver more targeted
treatment.
 The TEG System facilitates your understanding of hemorrhagic or
thrombotic risk by revealing:
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Rate of clot formation
Strength and stability of clot
Effect of platelet, coagulation factor, and cellular interactions
Maximum platelet function
Risk of hemorrhage and thrombosis, and identification of fibrinolysis
If a patient has been inhibited too much or too little
Copyright © 2009 Haemonetics Corp.
The TEG® System provides visual
representation of the patient’s hemostasis
Copyright © 2009 Haemonetics Corp.
Hemostasis stages
Initiation
Enzymatic part
Clotting Factors
Coagulation
Clot formation
Thrombin
Platelet part
Fibrin
Activation Platelets
Enzymatic part: Initiation of
coagulation is dependenton
coagulation factor
concentration
Platelet part: Thrombin
generation on the activated
platelets generate fibrin from
fibrinogen, which cross links
with platelets building the clot.
Dependent on platelets and
fibrinogen
Clot
Fibrinolysis
Fibrinolytic part
TPA / PAI
Clot Breakdown
Copyright © 2009 Haemonetics Corp.
Fibrinolytic part. Dissolves the
clot, dependent on fibrinand tPA
(from endothelial cells)
TEG® Tracing
R
R is the time of latency from the time that the blood was placed in the TEG® analyzer until the initial
fibrin formation.
a
The a value measures the rapidity (kinetics) of fibrin build-up and cross-linking, that is, the speed of
clot strengthening.
K
K time is a measure of the rapidity to reach a certain level of clot strength.
MA
MA, or Maximum Amplitude, is a direct function of the maximum dynamic properties of fibrin and
platelet bonding and represents the ultimate strength of the fibrin clot.
LY30
(EPL)
LY30 measures the rate of amplitude reduction 30 minutes after MA. This measurement gives an
indication of the stability of the clot.
Copyright © 2009 Haemonetics Corp.
Normal Hemostasis
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Delay of Clot Formation
Bleeding patient
Factor Deficiency or Heparin
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Heparin Effect
Heparinase Cup
Plain Cup
5.8
2.2
59.1
0.0
56.2
6.4
*2.0*
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*0.4*
-1.0
55.0
Low Platelet Function
Bleeding patient
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Primary Fibrinolysis
Bleeding patient
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Secondary Fibrinolysis
Bleeding patient
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DIC stadium 2
Bleeding patient
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Surgical patient, no DIC
Bleeding patient
Copyright © 2009 Haemonetics Corp.
This decision tree, using results from TEG® analysis, helps identify the coagulopathy and
in the case of fibrinolysis, can distinguish between primary and secondary fibrinolysis. The
TEG® system is unique in that it can easily distinguish between the two. In the case of
hypercoagulability, it can distinguish between platelet-induced vs enzymatic
hypercoagulability.
Copyright © 2009 Haemonetics Corp.
Suggested treatment
 Having identified the coagulopathy present, the specific values
generated by the TEG® system are used in the Treatment Guide to
arrive at a therapy decision. Several TEG® tests are categorized, so
that not only is the type of treatment identified, but a suggested
dosage is presented to help guide therapy.
 For example, clotting factors are characterized as slightly lower and
greatly lower than normal based on the TEG® R test, and the R test
results are given ranges to determine optimal treatment levels for
clotting factor disorders.
 Each of these treatment suggestions are supported by multiple peerreviewed articles written by users of the TEG® system, and are
available from Haemoscope Corporation or your local representative.
Copyright © 2009 Haemonetics Corp.
Suggested treatment
Treatment protocol
TEG® value
21
Clinical cause
Suggested Treatment
R between 7 - 10 min
 clotting factors
x 1 FFP or 4 ml/kg
R between 11-14 min
 clotting factors
x 2 FFP or 8 ml/kg
R greater than 14 min
 clotting factors
x 4 FFP or 16 ml/kg
MA between 49 -54 mm
 platelet function
0.3mcg/kg DDAVP
MA between 41 -48 mm
 platelet function
x5 platelet units
MA at 40 mm or less
 platelet function
x10 platelet units
a less than 45°
 fibrinogen level
.06 u/kg cryo
LY30 at 7.5% or greater, C.I. < 3.0
Primary fibrinolysis
antifibrinolytic of choice
LY30 at 7.5% or greater, C.I. > 3.0
Secondary fibrinolysis
anticoagulant of choice
LY30 < 7.5%, C.I. > 3.0
Prothrombotic state
anticoagulant of choice
Copyright © 2009 Haemonetics Corp.
TEG® Applications
 Cardiac Surgery
Trauma
 Cath lab
Obstetrics
 Vascular Surgery
Gyneacology
 Liver transplants
Orthopedics
 ICU
Pediatric Surgery
Copyright © 2009 Haemonetics Corp.
Added Value—Understanding platelet inhibition
through the PlateletMapping® Assay
 How do you know if 50% inhibition is good or bad, if you don’t know the patient’s
baseline risk?
 Many protocols require patients to come off Plavix® and aspirin prior to surgery in order
to minimize the risk of bleeding. But what if you interrupt anti-platelet medication on a
patient who is already predisposed to thrombotic events?
 Facilitating or inhibiting platelet function before surgery—without understanding the
patient’s baseline function—could put your patient at risk for a thrombotic or
hemorrhagic event, and increase the cost of patient care: administering too little could
lead to clotting, while administering too much could lead to bleeding.
 The TEG PlateletMapping® Assay measures platelet function and tells you the
patient’s level of inhibition as it relates to his baseline function, providing insight into his
relative thrombotic or hemorrhagic risk. With this information at hand, you can be more
confident making treatment decisions.
Copyright © 2009 Haemonetics Corp.
The TEG® System tells you more than the level of
inhibition
Copyright © 2009 Haemonetics Corp.
Clinical Evidence
 Dr. Linda Shore-Lesserson, in her prospective study of cardiac surgery,
showed a reduction in postoperative transfusion incidence of non-RBC
blood products from 25% in the standard coagulation test-guided group
to 5.6% in the TEG®-guided group.
Shore-Lesserson L, Manspeizer HE, Francis S, DePerio M. "[Thrombelastograph®
Analysis] Decreases Transfusion Requirements after Cardiac Surgery." Anesthesiology.
Sept. 1998, V89, No3A, A246.
Copyright © 2009 Haemonetics Corp.
Clinical Evidence
 Dr. David Royston and Stephen von Kier in a prospective study showed
that "[u]se of heparinase-modified TEG® monitoring was associated
with a three-fold reduction in use of hemostatic factors resulting in more
appropriate ordering of products and greatly reduced costs."
Von Kier S, Royston D. "Reduced Hemostatic Factor Transfusion
using Heparinase-Modified [Thrombelastograph® Analysis]
(TEG[®]) During Cardiopulmonary Bypass (CPB)." Anesthesiology.
Sept. 1998, V89, No. 3A, A911.
Copyright © 2009 Haemonetics Corp.
Clinical Evidence
 D.J. Plevak et al conducted a study on liver transplant patients to show
blood/donor conservation and cost per test using the TEG® coagulation
analyzer rather than commonly-used coagulation tests (CCT).
 The TEG® system was designed to be specific in determining whether
the developing clot can sustain hemostasis. If it can, then the use of
commonly-used coagulation tests adds unnecessary cost.
Plevak DJ, Divertie GD, Carton E, Bowie EJ, Rettke SR, Taswell HF, Wiesner RH.
"Blood Product Transfusion Therapy after Liver Transplantation(LT): Comparison of
the [Thrombelastogram®] (TEG[®]) and Conventional Coagulation Studies (CCS)."
Congress of the International Liver Transplantation Society. April 29-May 2, 1992.
p72.
Copyright © 2009 Haemonetics Corp.
The TEG® System Benefits
 Understand the full picture of the patient´s hemostasis
 Be more confident making treatment decisions.
 Avoid giving patients unnecessary transfusions.
 Give the right blood product to the right patient at the right time.
 Help to better patient outcome
 More economical transfusion practice
Copyright © 2009 Haemonetics Corp.
Litterature
Application of the TEG® has been described in articles published in many of the most
prestigious peer-reviewed journals such as:
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Anesthesiology
Anesthesia and Analgesia
Anesthesia and Intensive Care
Annals of Thoracic Surgery
British Journal of Anesthesia
British Journal of Urology
Journal of Cardiothoracic and Vascular Anesthesia
Journal of Clinical Anesthesia
Journal of Clinical Monitoring
Journal of Heart and Lung Transplantation
Journal of Neurology, Neurosurgery and Psychiatry
Applications also appear in medical texts and in proceedings of various
professional organizations.
Copyright © 2009 Haemonetics Corp.
Thank you for your attention!
The End
Orit Kassuto
Sales & Marketing Manager
Office: 972-4-9099110/103
Mobile: 972-50-6956002
orit.kassuto@medigal.com
Nufar Cohen Yablonovich
Product Manager - Patient Division
Office: 972-4-9099110
Mobile: 972-50-5684683
nufar.y@medigal.com
Copyright © 2009 Haemonetics Corp.