[HSF] Aprotinin and TEG

[Ben Bidstrup]

How are you using it? Which software do you have ?

>Michael,
>It is just because I do quite a few patients early after clopidogrel 
>loading because it is perceived,rightly or wrongly, that they are 
>less of a problem if done off pump.
>We have seen cases with normal TEG who are obviously coagulopathic 
>and sometimes the complete opposite where TEG looks terrible but 
>bleeding looks OK. I believe that post pump and certainly in your 
>setting it is a very useful test. I am not rubbishing  it, just 
>disappointed that it doesn't seem to pick platelet dysfunction 
>reliably.
>Don
>On 21/11/2006, at 9:35 AM, Michael Firstenberg wrote:
>
>>Don,
>>We have been using TEGs more and more to manage anticoag in our VAD 
>>patients and have been very happy with the results.  I thought the 
>>strength was measuring the effects of ASA/Plavix.  Why do you feel 
>>that it is unreliable pre-op?
>>
>>
>>-michael
>>
>>
>>On Nov 20, 2006, at 3:43 AM, Donald Ross wrote:
>>
>>>Just a word on aprotinin and platelet poisons.
>>>We have the latest TEG machine and have found it to be unreliable 
>>>for diagnosing platelet dysfunction prior to surgery in cases 
>>>dosed up with aspirin or clopidogrel.
>>>I use the very cheap eyeball test of the state of bleeding prior 
>>>to heparin. We all know what a coagulopathy looks like clinically 
>>>after the sternum has been split. I only use aprotinin in this 
>>>situation if I make the diagnosis clinically. The TEG has false 
>>>positive and negative errors according to clinical bleeding 
>>>associated with clopidogrel.
>>>This is not to denigrate its use for diagnosis in post op coagulopathy.
>>>Don
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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon