A comparison of kaolin-activated versus nonkaolin-activated thromboelastography in native and citrated blood

Sheila Sherlock Hepatobiliarypancreatic and Liver Transplantation Unit, Royal Free Hospital, London, UK.
Blood Coagulation and Fibrinolysis (Impact Factor: 1.4). 09/2008; 19(6):495-501. DOI: 10.1097/MBC.0b013e3282f9adf9
Source: PubMed


Thromboelastography can be performed with native or citrated blood (a surrogate to native blood in healthy controls, surgical and cirrhotic patients). Activators such as kaolin are increasingly used to reduce the time to trace generation. To compare kaolin-activated thromboelastography with nonkaolin-activated thromboelastography of native and citrated blood in patients with liver disease, patients undergoing treatment with warfarin or low-molecular weight heparin and healthy volunteers. We studied thromboelastography parameters in 21 healthy volunteers (group 1) and 50 patients, including 20 patients with liver cirrhosis with a nonbiliary aetiology (group 2), 10 patients with primary biliary cirrhosis or primary sclerosing cholangitis (group 3), 10 patients on warfarin treatment (group 4) and 10 patients with enoxaparin prophylaxis (group 5). Thromboelastography was performed using four methods: native blood (kaolin-activated and nonkaolin-activated) and citrated blood (kaolin-activated and nonkaolin-activated). For all thromboelastography parameters, correlation was poor (Spearman correlation coefficient < 0.70) between nonkaolin-activated and kaolin-activated thromboelastography, for both citrated and native blood. In healthy volunteers, in patients with liver disease and in those receiving anticoagulant treatment, there was a poor correlation between nonkaolin-activated and kaolin-activated thromboelastography. Kaolin-activated thromboelastography needs further validation before routine clinical use in these settings, and the specific methodology must be considered in comparing published studies.

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    • "Of the studies using TEG, only one study reported the use of kaolin activation [49]; the others only recalcified samples before testing. Of note, correlation between non-kaolin-activated and kaolin-activated thromboelastography has shown to be poor [61]. Furthermore, in some studies, a potential heparin effect was blocked by the addition of heparinase [9,40,44,50,52,54], whereas others lacked information on the use of heparinase [10,42]. "
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