SARS-CoV-2 infection was confirmed on real-time PCR assay. Routine blood examinations included 1) complete blood count, 2) coagulation profile, 3) serum biochemical tests (including renal and liver function, LDH, and electrolytes), 4) myocardial enzymes, and 5) serum ferritin. Overall coagulation state and fibrinolysis were assessed using thromboelastography (TEG 6; Haemonetics) (see online supplement for interpretation). The frequency of investigations and further tests were determined by the treating physicians.
Teg 6
Manufactured by Haemonetics
Sourced in United States
The TEG®6s is a viscoelastic hemostasis analyzer that measures the kinetics of clot formation and dissolution. It provides quantitative information on the different phases of the coagulation process, including the rate of clot formation, clot strength, and fibrinolysis.
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Lab products found in correlation
6 protocols using teg 6
1
Comprehensive Blood Profiling in SARS-CoV-2
2
Transfusion Guidance for ECLS Patients
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Transfusion management was the same at both institutions and was in concordance with Extracorporeal Life Support Organisation (ELSO) guidelines. The transfusion thresholds were haemoglobin ≤ 70 g/L, platelet < 50 × 109/L and fibrinogen < 1 g/L9. If there was no clinically significant bleeding, lower platelet counts and fibrinogen levels were accepted by treating intensivists. Viscoelastic coagulation testing (ROTEM Sigma, Werfen, Barcelona, Spain, in Cambridge; TEG 6, Haemonetics, Boston, MA, USA, in Manchester) was used alongside laboratory values to guide transfusion requirements.
3
Coagulation Assessment in COVID-19 Patients
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All enrolled patients had blood collected into a citrated tube for coagulation assessment using thromboelastography with the TEG®6s, Haemonetics, Braintree, MA, USA, at three set time points during hospital admission:
Time point 1 (day of admission, either before enoxaparin administration or at least four hours after enoxaparin administration)
Time point 2 (48 hours, three hours postenoxaparin administration)
Time point 3 (resolution of hypoxemia—off oxygen therapy, three hours postenoxaparin administration) or on day 10 of admission, whichever occurred first
4
Rapid Thromboelastography (TEG6s) for Coagulation Assessment
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A TEG6s was implemented (Haemonetics Inc., Braintree, MA, USA) and analyses were conducted within 30 minutes according to the manufacturer’s instructions. [17 (link)] In contrast to previous devices, no handling of reagents was necessary. The cartridges contained all required reagents in four microfluidic channels: kaolin in the CK-channel, kaolin and tissue factor in the CRT-channel, kaolin and heparinase in the CKH-channel, as well as kaolin and abciximab in the CFF-channel. A small amount of citrated whole blood (0.3 ml) was pipetted into the cartridge, the carriage was placed in the device, and determination of the assays was initiated automatically. An optical detector measured the movements of a blood meniscus exposed to a fixed vibration frequency range and results were transformed to the TEG readout. More details are described elsewhere. [17 (link)] For the purpose of our study, we recorded the clotting time (R) and maximum clot strength (MA).
5
Baseline Coagulation Assessment Pre- and Post-CPB
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Baseline investigations were performed following induction of anaesthesia, but prior to systemic heparinisation. These were the following: kaolin ACT, kaolin and heparinase TEG, full blood examination, prothrombin time (PT), and activated partial thromboplastin time (aPTT). TEG parameters were measured using the TEG 5000 or TEG 6s devices (Haemonetics, Braintree, Massachusetts, USA). These investigations were repeated 3 minutes after protamine administration following separation from CPB to ensure complete circulation of protamine before sampling was performed.
6
Viscoelastic Properties and Coagulation Markers
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The viscoelastic properties were analyzed using the TEG 6 s® platform (Haemonetics, Boston, MA), [13 (link)] the citrated multichannel cartridge facilitates the simultaneous performance of the citrated kaolin (CK), citrated kaolin with heparinase (CKH), citrated rapidTEG® (CRT), and citrated functional fibrinogen (CFF) assays. R-time (R), angle (A), maximal amplitude (MA), and lysis at 30 min (Lys30) from the standard (kaolin) and heparinase curves were analyzed.
International Normalized Ratio (INR), activated partial thromboplastin time, anti-factor Xa and Fibrin D-dimer were all analyzed on a STA-R Max2 (Stago, Asnières-sur-Seine, France). The reagent used for the PK/INR method was STA SPA+ from Stago, Catalogue number 00330 STA. The reagent is used for determination of the combined Factors II, VII and X. Coagulation samples were taken every morning except anti-factor Xa which was taken approximately 4 h after subcutaneous injection of dalteparin. The limit of quantification for the anti-factor Xa assay was 0.1 kIU/L and the total coefficient of variation was 4.5% at 0.56 kIU/L. The limits of quantification for the D-dimer assay was 0.27 mg/L and the total coefficient of variation was 4.2% at 2.16 mg/L.
International Normalized Ratio (INR), activated partial thromboplastin time, anti-factor Xa and Fibrin D-dimer were all analyzed on a STA-R Max2 (Stago, Asnières-sur-Seine, France). The reagent used for the PK/INR method was STA SPA+ from Stago, Catalogue number 00330 STA. The reagent is used for determination of the combined Factors II, VII and X. Coagulation samples were taken every morning except anti-factor Xa which was taken approximately 4 h after subcutaneous injection of dalteparin. The limit of quantification for the anti-factor Xa assay was 0.1 kIU/L and the total coefficient of variation was 4.5% at 0.56 kIU/L. The limits of quantification for the D-dimer assay was 0.27 mg/L and the total coefficient of variation was 4.2% at 2.16 mg/L.
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