TEG ORDERING GUIDELINES

PATIENT MED:


YOU ORDER:


YOU LOOK FOR:


ANY antiplatelet agent, 
SSRI/SNRI (see below), tramadol, claudication agent, THC, opioids (see below)   


TEG with PlateletMapping
 


NET G (NET CLOT STABILITY) GREATER THAN 5.5, THE HIGHER THE BETTER, BUT OVER 11 INDICATES RISK OF THROMBOSIS


ANY OTHER PATIENT

BasicTEG

G (CLOT STABILITY) GREATER THAN 5.5, THE HIGHER THE BETTER, BUT OVER 11 INDICATES RISK OF THROMBOSIS


Direct platelet inhibitors include aspirin, NSAIDS, and similar agents (COX inhibitors); ADP receptor inhibitor class (clopidogrel/Plavix, prasugrel/Effient), ticlodipine/Ticlid; GPIIb/IIA inhibitors (Reopro, Integrilin, Aggrastat); and others (e.g.; dipyridamole–Persantine and Aggranox; prostaglandin inhibitors). These drugs may show effects as long as five days after cessation.

Indirect inhibition may be an effect of SSRI/SNRI agents; the central increase in serotonin is accompanied by a peripheral decrease in serotonin, which decreases platelet function. PlateletMapping is appropriate in these cases. 

We have seen patients with detectable THC in blood or with reported marijuana use exhibit decreased MA/clot strength on PlateletMapping. Of five patients, only one had clinical bleeding.

Recent studies have indicated opioid-induced platelet inhibition.



                   SSRIs

                  SNRIs

Agent

citralopram

sertraline

fluoxetine

paroxetene

fluvoxatine

escitalopram

vortioxetene

Example brand

Celexa

Zoloft

Prozac

Paxil

Luvox

Lexapro

Brintellix

 Agent

duloxetine

venlaxafine

desvenlaxafine

milnacipran

levomilnacipran

Example brand

Cymbalta

Effexor

Pristiq

Savella

Fetzima