PlateletMapping Assay TEG Analysis - Perfusion.com
PlateletMapping Assay TEG Analysis - Perfusion.com
PlateletMapping Assay TEG Analysis - Perfusion.com
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Monitoring Hemostasis with the<br />
<strong>TEG</strong>®<br />
Mike Miller<br />
Manager <strong>TEG</strong>® Clinical Specialists<br />
Haemonetics
Disclosures<br />
� Employed by Haemonetics corporation<br />
Copyright © 2009 Haemonetics Corp.
� Heparin recognition<br />
� Rebound Heparin<br />
Case objectives<br />
� Hespan® on platelet function<br />
� Primary Fibrinolysis<br />
� Platelet Mapping in CV surgery<br />
� Blood utilization<br />
Copyright © 2009 Haemonetics Corp.
Baseline Pt on heparin<br />
Copyright © 2009 Haemonetics Corp.
Baseline Pt. 1<br />
AVR<br />
Copyright © 2009 Haemonetics Corp.
Pt. 1, 5 hours post protamine<br />
AVR<br />
Copyright © 2009 Haemonetics Corp.
Pt. #2 Baseline<br />
Copyright © 2009 Haemonetics Corp.
Pt. #2 Post Prot. 1<br />
Copyright © 2009 Haemonetics Corp.
Pt. #2 Post Prot. 2 nd dose<br />
Copyright © 2009 Haemonetics Corp.
Pt. #2, 2hrs later<br />
Copyright © 2009 Haemonetics Corp.
Pt. #2, 8hrs later<br />
Copyright © 2009 Haemonetics Corp.
Pt. # 3 Baseline<br />
Copyright © 2009 Haemonetics Corp.
Pt. #3, Post Protamine<br />
Copyright © 2009 Haemonetics Corp.
Pt. #3 Post Hespan<br />
Copyright © 2009 Haemonetics Corp.
Pt. #4 CABG<br />
Copyright © 2009 Haemonetics Corp.
Pt. #4 Post Protamine<br />
Copyright © 2009 Haemonetics Corp.
Pt. #4 post Hespan<br />
Copyright © 2009 Haemonetics Corp.
Pt. # 5 Baseline<br />
Copyright © 2009 Haemonetics Corp.
Pt. # 5 Post Protamine<br />
Copyright © 2009 Haemonetics Corp.
Pt. # 5 Post 2 units Hespan<br />
Copyright © 2009 Haemonetics Corp.
Pt.#6 Baseline heparinase cup<br />
Copyright © 2009 Haemonetics Corp.
Primary fibrinolysis<br />
Low platelet function<br />
Low factors<br />
patient received 4 FFP, 2 Platelets, 13 mg DDAVP,<br />
15g Amicar during the case, 1g drip Amicar 24 hrs<br />
post .
Post protamine<br />
Copyright © 2009 Haemonetics Corp.
<strong>PlateletMapping</strong> ® <strong>Assay</strong><br />
Monitoring platelet inhibitors<br />
with the <strong>TEG</strong> analyzer
<strong>PlateletMapping</strong><br />
What is it?<br />
� Measures the effect of antiplatelet agents on platelet<br />
function<br />
� Measures the patient’s maximum platelet function as a<br />
reference point<br />
� Measures the percentage of inhibition relative to the<br />
patient’s reference point<br />
Copyright © 2009 Haemonetics Corp.
Antiplatelet drugs<br />
� ADP receptor inhibitors<br />
<strong>PlateletMapping</strong><br />
What drugs are monitored?<br />
� Examples: clopidogrel, ticlopidine, prasurgrel<br />
� Arachidonic acid pathway inhibitors<br />
� Example: aspirin, nsaids<br />
� GPIIb/IIIa inhibitors<br />
� Examples: abciximab, tirofiban, eptifibatide<br />
Copyright © 2009 Haemonetics Corp.
Why <strong>PlateletMapping</strong>?<br />
Personalized Platelet Therapy<br />
Copyright © 2009 Haemonetics Corp.<br />
� Individual response to<br />
antiplatelet drugs<br />
determines clinical<br />
out<strong>com</strong>e<br />
� Knowing percent of<br />
platelet inhibition is<br />
insufficient to determine<br />
therapeutic efficacy<br />
� Knowledge of maximum<br />
platelet function is also<br />
required as a reference<br />
point
<strong>PlateletMapping</strong> <strong>Assay</strong><br />
<strong>TEG</strong> <strong>Analysis</strong>: MA<br />
75.0<br />
20.7<br />
10.0<br />
MA THROMBIN (<strong>com</strong>plete activation)<br />
% inhibition = 100 – [(MA pi-MA f)/(MA t-MA f) X 100]<br />
MA ADP or MA AA (activation of non-inhibited platelets)<br />
MA FIBRIN (no activation)<br />
Copyright © 2009 Haemonetics Corp.<br />
% Inhibition = 83.5<br />
% Aggregation = 16.5
<strong>PlateletMapping</strong> <strong>Assay</strong><br />
<strong>TEG</strong> <strong>Analysis</strong>: Clopidogrel Resistance<br />
75.0<br />
69.5<br />
10.0<br />
MA THROMBIN<br />
MA ADP<br />
% inhibition = 100 – [(MA pi-MA f)/(MA t-MA f) X 100]<br />
Copyright © 2009 Haemonetics Corp.<br />
MA FIBRIN<br />
% Inhibition = 8.5<br />
% Aggregation = 91.5
<strong>PlateletMapping</strong> <strong>Assay</strong><br />
<strong>TEG</strong> <strong>Analysis</strong>: Plavix<br />
MA ADP<br />
MA THROMBIN<br />
MA FIBRIN<br />
Copyright © 2009 Haemonetics Corp.
<strong>PlateletMapping</strong> <strong>Assay</strong><br />
<strong>TEG</strong> <strong>Analysis</strong>: Aspirin<br />
MA THROMBIN<br />
MA AA<br />
MA FIBRIN<br />
Copyright © 2009 Haemonetics Corp.
Baseline: Pt on PLAVIX®<br />
Copyright © 2009 Haemonetics Corp.
Before PLAVIX®<br />
Copyright © 2009 Haemonetics Corp.
5 hours post PLAVIX®<br />
Copyright © 2009 Haemonetics Corp.
Pt is not on PLAVIX®<br />
Copyright © 2009 Haemonetics Corp.
Pt on PLAVIX®<br />
Copyright © 2009 Haemonetics Corp.
PLAVIX® CAN Surgery be delayed?<br />
Copyright © 2009 Haemonetics Corp.
Pt on PLAVIX®<br />
Copyright © 2009 Haemonetics Corp.
Cases<br />
Questions<br />
Thank You!<br />
Copyright © 2009 Haemonetics Corp.
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