Update for Nurse Anesthetists Thromboelastography: Clinical Application, Interpretation, and Transfusion Management

Introduction The coagulation cascade is a dynamic process dependent on many factors. It involves interaction between primary hemostasis, platelet clot formation, secondary hemostasis, thrombin generation, and fibrinolysis. The assessment of this process is particularly important in the surgical patient to properly assess patient coagulation assessment, manage hemostatic therapy and transfusion in trauma and perioperative care, and assess bleeding in hemophilic patients. Complex surgical patients may require targeted hemostatic therapy using blood products and hemostasisaltering medications. Traditionally, coagulation tests used to guide transfusion management have included platelet count, activated partial thromboplastin time (aPTT), prothrombin time (PT), international normalized ratio, and activated clotting time (ACT), among others. Although these tests provide the practitioner with valuable information, they lack the ability to measure platelet function. However, some argue that screening for coagulation abnormalities and application of hemostatic interventions based on classical coagulation tests such as PT and aPTT are of limited value in perioperative and acutely ill patients. Also, the ability to measure whole blood coagulation, including platelet function, and not just the number of platelets, can be critical when a healthcare provider is determining what products are appropriate for a particular patient during surgery, or promptly determining when a patient might need to return to surgery for surgical hemostasis when a thromboelastography (TEG) assay is normal. One possible solution to this deficit in traditional co1