Comparative analysis of whole blood clot viscoelastic properties via thromboelastography and plasma fibrin clot characteristics.

BACKGROUND

Thromboelastography (TEG) is used in various clinical settings to assess clot formation, strength, and lysis. It is unknown whether TEG measures correspond to plasma fibrin clot characteristics.

METHODS

In 90 individuals free of cardiovascular disease (51 [56.7%] women, aged 49.3 ± 5.2 years, body-mass index [BMI], 26 [23.8-29.3] kg/m2) we assessed whole blood clot parameters (reaction [R] and clot formation [K] time, clot growth kinetics [angle], maximum amplitude [MA], and clot lysis [LY30]) using the TEG 6s analyzer (Haemonetics, Boston, US), plasma clot permeability (Ks), and clot lysis time (CLT) using three assays: (1) by Pieters (CLT-2018), (2) by Lisman (CLT), and (3) by Carter (Lys50).

RESULTS

There were associations of Ks with K time (R = 0.29, p = 0.0053), angle (R = -0.31, p = 0.0033), and MA (R = -0.47, p < 0.0001), while CLT tended to correlate with LY30. In women compared to men Ks was 8.4% lower corresponding to 7% higher MA (both p < 0.001). In obese (n = 19, 21.1%) vs. non-obese individuals angle was 5% larger (p = 0.029) but BMI did not correlate with TEG measures. TEG parameters and fibrin clot properties were unaffected by smoking, hypertension or hyperlipidemia. More efficient fibrinolysis (LY30 > 2.6%) was detected in 15 (16.7%) individuals who had also shorter CLT-2018 and CLT (both p < 0.05). Hypofibrinolysis (CLT-2018 > 300 min; n = 8, 8.9%) was detected only using CLT with no differences in TEG indices or Lys50.

CONCLUSIONS

TEG and plasma fibrin clot properties are complementary methods for assessing hemostasis, however, fibrin clot properties better reflect the impact of clinical risk factors on fibrinogen modification.