Comparison Between Thromboelastography and Conventional Coagulation Test: Should We Abandon Conventional Coagulation Tests in Polytrauma Patients?

Abstract Introduction Thromboelastography (TEG) provides an in vivo assessment of viscoelastic clot strength in whole blood compared with a conventional coagulation test (CCT), which may not reflect the influence of platelets. The aim of this study was to compare TEG vs CCT in trauma patients stratified by mechanism of injury (MOI) and pre-existing coagulation status. Methods A retrospective, observational study of 230 polytrauma patients admitted to a University Hospital Level 1 Trauma Center, with TEG and CCT on admission stratified by MOI: multiple trauma (MT), isolated traumatic brain injury (TBI) or MT + TBI. Statistical analysis included correlation between TEG and CCT in all groups and a subgroup analysis of anticoagulated patients. Data were analyzed with ANOVA, Spearman and lineal regression when appropriate. Statistical significance was accepted at P Results TEG was normal in 28.7%, hypercoagulable in 68.3% and hypocoagulable in 7%. There was no difference in TEG status among the groups. The coagulation status was not affected by age, ISS or shock. The CCT was abnormal in 63.6% of patients with normal TEG. Normal or hypercoagulable-TEG was found in 21 of 23 patients on Coumadin who had elevated international normalized ratio (INR) and in 10 of 11 patients on NOAC. An analysis of the 23 patients on Coumadin stratified by INR showed a normal or hypercoagulable-TEG in 21 of 23 patients. Only two patients had a hypocoagulable-TEG. Mortality was 5.2% (58.3% severe TBI). Conclusions TEG is more useful than CCT in polytrauma patients, including patients on anticoagulants. TBI could increase the incidence of hypercoagulability in trauma. CCT are not useful from the standpoint of treatment.