Why should I use TEG?
Virtually any patient at risk for coagulopathy--hemorrhagic or thrombotic--can probably benefit from TEG as part of the work-up. TEG can distinguish enzyme- and factor-driven coagulopathy from platelet-driven coagulopathy and can even delineate stage I DIC.
In our opinion, ANY patient on antiplatelet or anticoagulation therapy should be monitored with TEG. Ditto any patient with a personal or family history of pathologic thrombosis or hemorrhage. Did you know that perhaps half of patients who take Plavix derive no antiplatelet benefit from it, either due to genetic resistance or top interference form other drugs (such as Lipitor)? How do you know that your patient's Plavix is working properly, or that your patient is resounding properly to aspirin? Dany patient with a personal or family history of pathologic thrombosis or hemorrhage.
A bleeding patient with a normal TEG probably needs surgical intervention to stop the bleeding; it’s not a coagulopathy.
Why not INR or aPTT? Those tests use a bit of platelet-poor plasma; this simply cannot provide a reasonable estimate of the clotting ability of the patient's whole blood, as TEG can.
What are the limitations of TEG?
TEG cannot pinpoint specific factor deficiencies, but it can distinguish possible deficiencies from poor coagulation due to hemodilution.
What do I order?
If your patient is on ANY DIRECT PLATELET INHIBITOR (aspirin, Plavix, Effient, Aggrenox, NSAIDs, etc.), or SSRI/SNRI, order TEG with PlateletMapping.
In ANY OTHER CASE, order BasicTEG. Remember, Coumadin, Lovenox, Xarelto, Arixtra, etc., are NOT direct platelet inhibitors.
What if my patient is on Coumadin? Is TEG better than PT/INR?
We are not aware of direct studies comparing TEG with PT/INR in Coumadin monitoring. However, TEG WILL provide a excellent evaluation of your patient’s coagulation status.
Is TEG good for routine monitoring of other drugs?
TEG is an excellent choice for monitoring Factor II and Factor Xa inhibitors.
Is it expensive?
The typical hospital charge for BasicTEG is about $250 and for TEG with PlateletMapping is about $550. Of course, these are the list prices; actual reimbursed costs are lower.
Can my patient get this at other labs?
Locally, TEG is available only at the Kaweah Delta Medical Center laboratory. Currently, samples MUST be run within two hours of sample acquisition, so patients must come to the hospital lab for the test.