[HSF] Aprotinin and TEG

[Tea Acuff]

Do others have simiarly strong pro or con TEG biases and why?
Tea


----- Original Message ----
From: Donald Ross <donross at bigpond.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Tuesday, November 21, 2006 1:25:17 AM
Subject: Re: [HSF] Aprotinin and TEG


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
>> _______________________________________________
>> OpenHeart-L mailing list
>>
>> Send postings to:
>> OpenHeart-L at lists.hsforum.com
>>
>> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>> http://mmp.cjp.com/mailman/listinfo/openheart-l
>>
>> All messages transmitted by the OpenHeart-L are subject to the  
>> policies anddisclaimers posted at:
>> http://www.hsforum.com/listdisclaim
>> -----------------------------------------
>
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
> OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the  
> policies anddisclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
_______________________________________________
OpenHeart-L mailing list

Send postings to:
OpenHeart-L at lists.hsforum.com

To UNSUBSCRIBE, to CHANGE email address, or to view archives:
http://mmp.cjp.com/mailman/listinfo/openheart-l

All messages transmitted by the OpenHeart-L are subject to the policies and 
disclaimers posted at:
http://www.hsforum.com/listdisclaim
-----------------------------------------