Thromboelastography for Thrombotic and Bleeding Risk Assessment and Management in Image-Guided Interventions

Monday, March 31, 2025

5:10 PM – 5:15 PM CT

Location: Music City Center, 204

Abstract Presenter(s)

JL

Joshua Levy

Medical Student
Kirk Kerkorian School of Medicine at UNLV, United States

Author/Co-author(s)

MM

Marvi A. Moreno, MD

Resident Physician
Kirk Kerkorian School of Medicine at UNLV, United States
DV

Daniel Villegas, BS

Medical Student
Kirk Kerkorian School of Medicine at UNLV, United States
MH

Mohammed Hoque, MD

Attending Physician
Kirk Kerkorian School of Medicine, United States

Learning Objectives: To demonstrate thromboelastography (TEG) as a comprehensive assessment tool for hemostasis assessment and resuscitation guidance.

Background: Bleeding disorders are multifaceted and influenced by factors such as liver disease, heart problems, and kidney dysfunction. Each condition requires tailored management before and after procedures. Traditional blood tests, like PT, PTT, INR, thrombin time, fibrinogen, and platelet count, are used to assess bleeding risk. However, these tests have limitations in evaluating the dynamic nature of clot formation and breakdown {1}. Thromboelastography (TEG) is a point-of-care test that provides detailed information about fibrin formation, platelet activation, and clot retraction in real-time {2}. This coagulation assessment method has been increasingly utilized in surgery, anesthesiology, and other disciplines. A randomized controlled study showed that TEG-guided transfusion strategies reduced unnecessary blood transfusions in patients with liver disease and low platelet value undergoing high-risk procedures {3}. While TEG has become more adopted in various clinical settings, its use in Vascular and Interventional Radiology (VIR) remains unclear.

Clinical Findings/Procedure Details: A blood sample is placed in a well and gently agitated to mimic venous flow and activate coagulation. A clot then forms around a thin wire probe. A graph will then be generated, demonstrating the speed and strength of clot formation and providing 5 values: R-value, K, alpha angle, maximum amplitude, and LY30 {4}. The gathered data are then interpreted to assess bleeding risk and guide targeted resuscitation strategies (Table 1).

Conclusion and/or Teaching Points:
TEG is a dynamic assessment tool of coagulation that offers insight into a patient’s overall hemostatic status allowing for targeted resuscitation. While studies have demonstrated its utility in various clinical settings, further investigation is needed to establish its role in procedures performed in VIR.