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  • Phillip Gray

    25 January 2016

    Thrombelastograph (TEG)

    Coagulation Analyser

    The TEG System is indicated for use with adult patients when an evaluation of their blood hemostatic properties is desired. Results from the TEG analyser should not be the

    sole basis for a patient diagnosis; TEG results should be considered along with a clinical assessment of the patients condit ion and other coagulation laboratory tests. For

    Professional Use Only.

    Haemonetics, TEG, and Thrombelastograph are trademarks or registered trademarks of Haemonetics Corporation in the USA, other countries, or both. PlateletMapping is a

    registered trademark of Coramed Technologies, LLC. Effient is a registered trademark of Eli Lilly and Company. Plavix is a trademark of Bristol-Myers Squibb/Sanofi

    Pharmaceuticals Partnership.

    Please refer to the manuals for Indications for Use, Contraindications, Warnings, Precautions, and Potential Adverse Events.

  • 2 Haemonetics Corporation

    Individual Goal Directed

    Coagulation Management

    TEG 6s

    Making the Complex Simple

  • 3 Haemonetics Corporation

    A real time analyser of whole blood allowing for

    individualised goal-directed therapy.

    Measures the viscoelastic properties of the

    haemostasis process functionally, with the end-

    result being a haemostatic plug, or clot.

    What is TEG?

  • 4 Haemonetics Corporation

    Clinical Practice: A Constant Struggle

  • 5 Haemonetics Corporation

    Injury

    Disease

    Aging Process

    Cholesterol

    Hardening of Arteries

    Vascular Constriction

    and Breakdown

    Blood Activation by

    Turbulence

    Upsetting the balance

    Natural processes

  • 6 Haemonetics Corporation

    Surgery

    Devices LVADs,

    CPB, ECMO

    Trauma

    Drugs

    Stents

    Airplane Flights

    DVT

    Smoking

    Upsetting the balance

    Human intervention

  • 7 Haemonetics Corporation

    Multiple systems Cells

    56+ proteins

    Dynamic

    Interactive

    Complexity of haemostasis

  • Copyright 2011 Haemonetics Corp.

    F X

    F IXaF IX

    F XIaF XI

    Surface Contact

    Collagen

    FXII activator

    F XIIaF XII

    Intrinsic Pathway

    Ca2+

    Ca2+

    Ca2+ F X

    F VIIF VIIa

    F III (Tissue

    Thromboplastin)

    Tissue/Cell Defect

    Extrinsic Pathway

    Ca2+

    Ca2+

    FibrinogenFibrin

    monomers

    Fibrin

    polymers

    Thrombin IIaProthrombin II

    F Xa

    Ca2+

    Platelet Factor 3

    Crosslinked

    Fibrin Network

    F XIIIa F XIII

    F VF Va

    F VIIIaF VIII

    Yellow lines

    indicate

    positive

    feedback

    loops lost in

    isolated tests

    The Coagulation Cascade

  • 9 Haemonetics Corporation

    Traditional haemostasis monitoring

    Traditional

    Hemostasis

    Tests

    Do not define the overall process, just provide pieces of the process!

    D-Dimer

  • 10

    Cell-Based Model Reflects in vivo

    Occurring on cell surfaces

    Tissue factor bearing cells

    Platelets

    Overlapping phases:

    Initiation (TF bearing cells)

    Amplification (platelets)

    Propagation (platelets)

    The coagulation cascades are still important, but are cell-based

    extrinsic pathway: surface of tissue

    factor bearing cells

    intrinsic pathway: surface of

    platelets

    Routine coagulation tests do not represent the cell-based model of

    hemostasis

    [Monroe, DM. et al. Arterioscler Thromb Vasc Biol. 2002;22:1381]

    Tissue factor

    bearing cells

    1. Initiation

    Platelets

    Activated

    platelets

    2. Amplification

    3. Propagation

    IIa

    IIa

  • 11 Haemonetics Corporation

    TEG Technology

  • 12 Haemonetics Corporation

    1- INITIATION

    Haemostasis made simple with TEG

    Reaction

    INITIATION

    1

  • 13 Haemonetics Corporation

    1- INITIATION 2- STRENGTH

    Haemostasis made simple with TEG (2/3)

    Maximum clot

    STRENGTH

    2

    Reaction

    INITIATION

    1

  • 14 Haemonetics Corporation

    1- INITIATION 2- STRENGTH 3- STABILITY

    Haemostasis made simple with TEG (3/3)

    Maximum clot

    STRENGTH

    2

    Reaction

    INITIATION

    1

    Clot degradation

    STABILITY

    3

  • 15 Haemonetics Corporation

    TEG Core Assessment

    1. INITIATION

    2. STRENGTH

    3. STABILITY

    1 INITIATION

    2 STRENGTH 3 STABILITY

  • 16 Haemonetics Corporation

    TEG Trace Diagnostic Complex

  • 17 Haemonetics Corporation

    Heparin/Enoxaparin Effect

    Plain cup

    5.8 2.2 59.1 0.0 56.2 6.4

    Heparinase cup

  • 18 Haemonetics Corporation

    Functional Fibrinogen TEG

  • 19 Haemonetics Corporation

    Fibrinogen/Platelet Ratio

  • 20 Haemonetics Corporation

    Fibrinogen/Platelet Ratio

  • 21 Haemonetics Corporation

    Tissue Factor and Kaolin Activation

    RAPID test of CLOT STRENGTH and any FIBRINOLYSIS

    Also provides RAPID TEG ACT Result

    RapidTEG Assay

  • 22 Haemonetics Corporation

    Rapid TEG

  • 23 Haemonetics Corporation

    4 TEST CONCEPT

    Kaolin Activated

    Functional Fibrinogen

    Rapid TEG

    Heparinase

  • 24 Haemonetics Corporation

    4 TEST CONCEPT - Combination TEST

    Kaolin Activated Rapid TEG

    Functional Fibrinogen

    Early Diagnosis ~10 Min

    FastGlobalSensitivity to All Phases

  • 25 Haemonetics Corporation

    The TEG5000 Today

  • 26 Haemonetics Corporation

    The TEG5000 Software Today

  • 27 Haemonetics Corporation

    The TEG6s. TOMORROW

  • 28 Haemonetics Corporation

    TEG 6s

    Making the Complex Simple!

  • TEG 6s Test Procedure

  • 30 Haemonetics Corporation

    Patient Test Procedure

  • 31 Haemonetics Corporation

    TEG 6s Stand-Alone Device

  • 32 Haemonetics Corporation

    TEG 6s

    Complex Technology

    Resonance-frequency viscoelasticity measurements and

    disposable multi-channel microfluidic cartridges

  • 33 Haemonetics Corporation

    Sample ring subjected to external vibration

    Sample Testing

  • 34 Haemonetics Corporation

    Harmonic motion of sample measured optically

    Measurement

    Optical detection

  • 35 Haemonetics Corporation

    Click to play

    Sample Testing Animation

  • 36 Haemonetics Corporation

    As sample transitions from liquid to gel state,

    measurements are plotted: Clot strength vs. Time

    Measurement

    Time

    Clot

    strength

    Liquid

    state

    Gel

    state

  • 37 Haemonetics Corporation

    TEG 6s

    Tests

    Kaolin TEG Contact activator in routine use

    Heparinase cups Neutralises heparin to allow you to see patients underlying

    haemostatic profile

    RapidTEG Tissue Factor and Kaolin Activation for rapid testing of clot strength

    and also provides TEG ACT Result

    Functional

    Fibrinogen

    Functional fibrinogen reagent provides a functional measurement of

    patient fibrinogen level

    1. Global hemostasis cartridge (citrated tube - blue top)

    2. PlateletMapping cartridge (heparin tube green top)

    PlateletMapping Gives personalised antiplatelet therapy for both haemorrhagic and

    thrombotic condition

    3. QC cartridges

    Biological QC Level I and II

  • 38 Haemonetics Corporation

    The TEG 6s

    Making the Complex Simple

    Simplicity in Facilitating the Science of the Cell Based Model

  • 39 Haemonetics Corporation

    TEG 6s

    Advances the TEG 5000 legacy through simple,

    smart and reliable designSame Simple

    Smart Reliable

    Assess same physical property/results

  • 40 Haemonetics Corporation

    Kaolin TEG

    Rapid TEG

    Functional Fibrinogen

    TEG

    Heparinase effect

    Global Haemostasis Assessment

  • 41 Haemonetics Corporation

    TEG 6s COMBINATION TEST CONCEPT

    Global Impact: Fast and Specific Sensitivity

    Kaolin Activated Rapid TEG

    Functional Fibrinogen

    Early Diagnosis ~10 Min

    Global Haemostasis

  • 42

    1/17/201411:21 AMID: patientID1

    CM Citrated K,KH,RT,FF baseline1/16/2014

    11:21

    results next tracing

    CK

    CRT

    CKH

    CFF

    80

    60

    40

    20

    00 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85

    (min)

  • 43

    CM Citrated K,KH,RT,FF baseline

    R(min)

    K(min)

    Angle(deg)

    MA(mm)

    device 1User 1

    1/17/201411:21 AMID: patientID1

    done tracingsprint

    LY30(%)

    CK

    CRT

    CFF

    CKH

    5.84.6-9.1

    2.30-2.6

    73.463-78

    58.552-69

    59.752-70

    58.552.3-68.9

    19.8-15-32

    1.30.8-2.1

    73.460-78

    74.964.3-77.1

    1.60.8-2.7

    1.20.8-1.9

    0.30.3-1.1

    5.54.3-8.3

    1.50-2.2

    78.6 !82-152

    TEG-ACT(sec)

    361.3278-581

    FLEV(mg/dl)

    1/16/2014

    11:21

  • 44

    1/17/201411:21 AMID: patientID1

    CM Citrated K,KH,RT,FF baseline1/16/2014

    11:21

    results next tracing

    CK

    CRT

    CKH

    CFF

    0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85

  • 45

    1/17/201411:21 AMID: patientID1

    results next tracing

    CK

    80

    60

    40

    20

    00 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85

    R 5.8(min) 4.6-9.1

    K 1.3(min) 0.8-2.1

    Angle 73.4(deg) 63-78

    MA 58.5(mm) 52-69

    LY30 2.3(%) 0-2.6

    (min)

    CM Citrated K,KH,RT,FF baseline1/16/2014

    11:21

  • 46

    1/17/201411:21 AMID: patientID1

    results next tracing

    CKH

    80

    60

    40

    20

    00 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85

    (min)

    CM Citrated K,KH,RT,FF baseline1/16/2014

    11:21

    R 5.5(min) 4.3-8.3

    K 1.2(min) 0.8-1.9

    Angle 74.9(deg) 64.3-77.1

    MA 58.5(mm) 52.3-68.9

  • 47

    1/17/201411:21 AMID: patientID1

    results next tracing

    CRT

    80

    60

    40

    20

    00 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85

    (min)

    CM Citrated K,KH,RT,FF baseline1/16/2014

    11:21

    R 0.3(min) 0.3-1.1

    K 1.6(min) 0.8-2.7

    Angle 73.4(deg) 60-78

    MA 59.7(mm) 52-70

    LY30 1.5(%) 0-2.2

    TEG-ACT 78.6(sec) 82-152

  • 48

    1/17/201411:21 AMID: patientID1

    results next tracing

    CFF

    80

    60

    40

    20

    00 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85

    MA 19.8(mm) 15-32

    FLEV 361.3(mg/dl) 278-581

    (min)

    CM Citrated K,KH,RT,FF baseline1/16/2014

    11:21

  • 49

  • 50

    CM Citrated K,KH,RT,FF baseline

    R(min)

    K(min)

    Angle(deg)

    MA(mm)

    device 1User 1

    1/17/201411:21 AMID: patientID2

    done tracingsprint

    LY30(%)

    CK

    CRT

    CFF

    CKH

    5.84.6-9.1

    2.30-2.6

    73.463-78

    58.552-69

    59.752-70

    58.552.3-68.9

    19.8-15-32

    1.30.8-2.1

    73.460-78

    74.964.3-77.1

    1.60.8-2.7

    1.20.8-1.9

    0.30.3-1.1

    5.54.3-8.3

    1.50-2.2

    78.6 !82-152

    TEG-ACT(sec)

    361.3278-581

    FLEV(mg/dl)

    1/16/2014

    11:21

  • 51 Haemonetics Corporation

    TEG 6s Case Studies

  • Case Study 1: Re-warm sample

    pre-op INR 2.6

  • Case Study 1: Re-warm sample

    pre-op INR 2.6

  • Case Study 1:

    Post-protamine

  • Case Study 1:

    Post-protamine

  • Case Study 1: Post-protamine #2

    Post-transfusion 1 x plasma, 1 x thrombocyte,

    additional protamine

  • Case Study 1: Post-protamine #2

    Post-transfusion 1 x plasma, 1 x thrombocyte,

    additional protamine

  • Case Study 2: Post-protamine

  • Case Study 2: Post-protamine

  • 60 Haemonetics Corporation

    Aorte Ascendante Post-0p (Dr. Braunberger)

  • 61 Haemonetics Corporation

    Aorte Ascendante Post 1,5 g Fibrinogene

  • 62 Haemonetics Corporation

    Platelet Mapping: Measuring the potential impact of ant-Platelet therapy

    Measures Individualized response to drugs!

    INDIVIDUAL haemostatic baseline

    Individually affected by ANTI-PLATELET DRUGS

  • 63 Haemonetics Corporation

    Antiplatelet drugs ADP receptor inhibitors

    Examples: clopidogrel (Plavix), ticlopidine (Ticlid) prasugrel (Effient), ticagrelor (Brilinta)

    Thromboxane pathway inhibitors

    Example: aspirin

    GPIIb/IIIa inhibitors

    Examples: abciximab (Reopro), tirofiban(Aggrastat), eptifibatide (Integrilin)

    PlateletMappingWhat drugs are monitored?

  • 64 Haemonetics Corporation

    Platelet Mapping Combination Test

    Platelet

    Function

    Maximum

    ZERO

    Drug affect

    (60% Inhibition)

    (100% Aggregation)

    (0% Aggregation)

  • 65 Haemonetics Corporation

    What if they are all treated the same? (50% inhibition)

    Why PlateletMapping Assay?

    Personalized Platelet Therapy

  • 66 Haemonetics Corporation

    All 50% Inhibition

    Why PlateletMapping Assay?

    Personalized Platelet Therapy

  • 67

    1/17/201411:21 AMID: patientID1

    PM Platelet Mapping baseline1/16/2014

    11:21

    results next tracing

    HKH

    ActF

    ADP

    AA

    80

    60

    40

    20

    00 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85

    (min)

  • 68

    PM Platelet Mapping baseline

    HKH

    ActF

    AA

    ADP

    6.64.2-9.8

    ---0-2.4

    68.257-75

    61.854-70

    R(min)

    K(min)

    Angle(deg)

    MA(mm)

    device 1user 1

    1/17/201411:21 AMID: patientID1

    done tracingsprint

    7.62-19

    59.644-69

    61.937-71

    1.71-2.96

    LY30(%)

    0

    95.9

    100

    4.1

    Inhibition(%)

    Aggregation(%)

    ADP

    AA

    ADP

    AA

    1/16/2014

    11:21

  • 69

    1/17/201411:21 AMID: patientID1

    results next tracing

    HKH

    80

    60

    40

    20

    00 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85

    R 6.6(min) 4.2- 9.8

    K 1.7(min) 1- 2.9

    Angle 68.2(deg) 57- 75

    MA 61.8(mm) 54- 70

    LY30 ---(%) 0-2.4

    (min)

    PM Platelet Mapping baseline1/16/2014

    11:21

  • 70

    1/17/201411:21 AMID: patientID1

    results next tracing

    ActF

    80

    60

    40

    20

    00 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85

    (min)

    PM Platelet Mapping baseline1/16/2014

    11:21

    MA 7.6(mm) 2-19

  • 71

    1/17/201411:21 AMID: patientID1

    results next tracing

    ADP

    80

    60

    40

    20

    00 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85

    (min)

    PM Platelet Mapping baseline1/16/2014

    11:21

    MA 59.6(mm) 44-69

  • 72

    1/17/201411:21 AMID: patientID1

    results next tracing

    AA

    80

    60

    40

    20

    00 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85

    (min)

    PM Platelet Mapping baseline1/16/2014

    11:21

    MA 61.9(mm) 37- 71

  • 73 Haemonetics Corporation

    TEG 6s COMBINATION TEST CONCEPT

    Global Impact: Fast and Specific Sensitivity

    Kaolin Activated Rapid TEG

    Functional Fibrinogen

    Early Diagnosis ~10 Min

    Platelet Function

    Maximum

    ZERO

    Drug affect

    (60% Inhibition)

    (100%

    Aggregation)

    (0%

    Aggregation)

    Global Haemostasis

  • 74 Haemonetics Corporation

    TEGManager

    TEG Viewer

    +Device Manager

    = TEG Manager

  • 75 Haemonetics Corporation

    View real-time and

    historical TEG tests on

    remote monitors

    View multiple TEG

    tests per patient

    Color-coded by

    cartridge

    Share a view with

    others

    10 languages to start

    TEG Viewer

  • TEGManager = Two applications

    TEG Viewer

    TEGViewer:

    TEGManager leverages the TEG 6s data

    One way communications pull from the

    device

    Stores clinical test results from a fleet of TEG

    devices

    Displays active and historical TEG test results

    Provides patient trending data across multiple

    TEG devices

    Available on various screen sizes from iPad

    to large screen monitor

    Provides clinical and research reports

    Allows viewing of active and historical results

    on multiple screens & View status of all

    TEG 6s devices in the institution (operation,

    calibration, status, logs, firmware, cartridge

    configuration

    TEG Viewer + Device Manager = TEG Manager

  • TEG Viewer Main Screen

  • TEGManager = Two applications

    Device Manager

    Device Manager:

    Manages:

    User credentials & different level of

    access

    Network connectivity

    Bi-directional connectivity to devices

    Connectivity to middleware for Patient

    Identification

    Device-specific reports (i.e., uptime, error

    logs, etc.)

    Aggregates TEG data from several

    Analyzers into a centralized data repository

    Provides centralized administration (i.e.,

    User IDs)

    Connectivity between devices and

    middleware (HaemoCommunicator)

    TEG Viewer + Device Manager = TEG Manager

  • TEG Device Manager

    View status of all TEG 6s

    devices in the institution

    (operation, calibration,

    status, logs, firmware,

    cartridge configuration)

    Manage users on devices,

    their permissions, full data

    access reporting

    Model for managing

    Haemonetics devices

    moving forward

  • Hospital Network

    IT SERVICESWEB Access anywhere from any PC or tablet connect on the network

    Or higher

    With one of the following browser

    Operating room Biologists Office Doctors officeEverywhere

    Emergency Operating room Satellite Lab Etc.

    TEG : IT Architecture in Hospital

    http://www.google.fr/url?url=http://frawin.com/actualites-news-blog-generales/2014/26339_chrome-version-64-bit-disponible-en-version-stable-windows-7-8.html&rct=j&frm=1&q=&esrc=s&sa=U&ei=BXTwVNXPDcnoaI2vgJAK&ved=0CB4Q9QEwBA&usg=AFQjCNG5b6vHAuaBlvu0wYOipyDxDZDQpwhttp://www.google.fr/url?url=http://frawin.com/actualites-news-blog-generales/2014/26339_chrome-version-64-bit-disponible-en-version-stable-windows-7-8.html&rct=j&frm=1&q=&esrc=s&sa=U&ei=BXTwVNXPDcnoaI2vgJAK&ved=0CB4Q9QEwBA&usg=AFQjCNG5b6vHAuaBlvu0wYOipyDxDZDQpwhttp://www.google.fr/url?url=http://www.clubic.com/os-mobile/iphone-os/actualite-483430-safari-mobile-ios-faille-phishing-indetectable.html&rct=j&frm=1&q=&esrc=s&sa=U&ei=YnTwVI29DIniapnYgUg&ved=0CCgQ9QEwCQ&usg=AFQjCNFesr0Wl-9qLHf4mYwAlWK6o3a9LQhttp://www.google.fr/url?url=http://www.clubic.com/os-mobile/iphone-os/actualite-483430-safari-mobile-ios-faille-phishing-indetectable.html&rct=j&frm=1&q=&esrc=s&sa=U&ei=YnTwVI29DIniapnYgUg&ved=0CCgQ9QEwCQ&usg=AFQjCNFesr0Wl-9qLHf4mYwAlWK6o3a9LQhttp://www.google.fr/url?url=http://www.dator.fr/forcer-ie8-a-interpreter-les-pages-comme-ie7/&rct=j&frm=1&q=&esrc=s&sa=U&ei=2nPwVOi8OIixaYrZgtAG&ved=0CCIQ9QEwBg&usg=AFQjCNG_31mrkFgBz8DbeqUA-mZGUYQ67Ahttp://www.google.fr/url?url=http://www.dator.fr/forcer-ie8-a-interpreter-les-pages-comme-ie7/&rct=j&frm=1&q=&esrc=s&sa=U&ei=2nPwVOi8OIixaYrZgtAG&ved=0CCIQ9QEwBg&usg=AFQjCNG_31mrkFgBz8DbeqUA-mZGUYQ67Ahttps://www.google.fr/url?url=https://www.mozilla.org/en-US/styleguide/identity/firefox/wordmarks/&rct=j&frm=1&q=&esrc=s&sa=U&ei=KHTwVOejOZXmaofsglg&ved=0CB4Q9QEwBA&usg=AFQjCNHBc7coZcgBt_VqjGmy80VSB4gAqghttps://www.google.fr/url?url=https://www.mozilla.org/en-US/styleguide/identity/firefox/wordmarks/&rct=j&frm=1&q=&esrc=s&sa=U&ei=KHTwVOejOZXmaofsglg&ved=0CB4Q9QEwBA&usg=AFQjCNHBc7coZcgBt_VqjGmy80VSB4gAqghttp://www.google.fr/url?url=http://www.expert-digital.fr/veille-digitale/499-la-tablette-l-objet-incontournable-des-francais.html&rct=j&frm=1&q=&esrc=s&sa=U&ei=h3rwVMTXGcLkUsLNgxg&ved=0CCQQ9QEwBw&usg=AFQjCNF_0Xm8LB3l9XmfuuKWHzpEIynDjAhttp://www.google.fr/url?url=http://www.expert-digital.fr/veille-digitale/499-la-tablette-l-objet-incontournable-des-francais.html&rct=j&frm=1&q=&esrc=s&sa=U&ei=h3rwVMTXGcLkUsLNgxg&ved=0CCQQ9QEwBw&usg=AFQjCNF_0Xm8LB3l9XmfuuKWHzpEIynDjA

  • Unrivalled performance with TEG6s

  • ProtocolsWhen to Sample?

    How to Treat?

  • 83

    Cardiac Surgery TEG Protocol

    TEG Protocol When Tube

    Global Haemostasis

    or

    Platelet

    Mapping

    Either Day before or on induction:

    Prior to heparin and hemodilution

    Blue Top: Patient Label and

    time sample drawn.

    Green Top: Patient Label and

    time sample drawn

    Re-warm Blood Temperature 35-36 Degrees C (20 minutes prior to coming off

    bypass)

    Blue Top: Patient Label and

    time sample drawn.

    Post-Protamine

    Ten Minutes post protamine (Same

    time ACT drawn) Blue Top: Patient Label and

    time sample drawn.

    Post Op Two Hour Post protamine (ICU

    sample) or upon bleeding

    Blue Top: Patient Label and

    time sample drawn

  • 84 Haemonetics Corporation

    Adapted from: Agarwal S et al. J Cardiothorac Vasc Anesth. 2014

    Pre-Bypass Platelet Function Testing TEG PlateletMapping

    Pre-Bypass Kaolin TEG

    Pre-Bypass Functional Fibrionogen TEG

    Check Kaolin and Heparinase TEG

    Post-Protamine Functional Fibrionogen TEG

    Check Pre-Bypass

    Platelet Function Test

    Transfuse 2 pools

    platelets

    Transfuse 1 pool

    platelets

    Administer 50mg

    Protamine

    Transfuse 8ml/kg

    FFP

    Transfuse 16ml/kg

    FFP

    Transfuse 1 pool

    platelets*

    Transfuse 1 pool

    platelets*

    Check Functional Fibrinogen TEG **

    Is

    PLM ADP Inhibition

    >70%?

    Is

    PLM ADP Inhibition

    >60%?

    Transfuse 10 units

    Cryoprecipitate

    Post-Protamine Kaolin and Heparinase TEG

    Is the

    Kaolin R time

    >2 Heparinase

    R time?

    Is the

    R time 10 and

    < 14 min?

    Is the R time

    > 14 min?

    Is MA

  • 85 Haemonetics Corporation COL-COPY-000864-IE(AA)

    ECLS et TEG

  • 86 Haemonetics Corporation COL-COPY-000864-IE(AA)

    TEG et CIVD

  • Septic Patient DIC?

    Patient presented in ED with suspected Meningitis.

    TEG shows classic Stage 1 DIC tracing

  • Septic Patient DIC?

    2 hours after administration of heparin 10u/kg iv followed by 10u/kg/hr drip. Note that the patient is no longer hypercoagulable under heparin, but when heparin is removed with heparinase, condition reverts (red tracing).

  • Septic Patient DIC?

    12 hours later the heparin effect is more pronounced

    (extended R) and normal values on heparinase tracing

    (red). Heparin dose can now be reduced.

  • Septic Patient DIC?

    36 hours after treatment with heparin begun. Dose has been reduced to 5u/kg/hr. Note no reversion to hypercoagulable values in heparinase (red tracing). Condition resolved. Patient subsequently extubated and transferred to the floor.

  • Questions?