[HSF] Aprotinin and TEG

[Donald Ross]

We use the Teg 5000 with Verson 4 software.
How do we use it?
I hope as it is supposed to be used!
Any tips?

On 21/11/2006, at 10:21 PM, Ben Bidstrup wrote:

> 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
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