Thromboelastography-guided transfusion parameters

r-TEG parameter	Normal range	Transfusion trigger
TEG-ACT	78-110 seconds	>128 seconds (FFP)
Alpha angle	66°-82°	<65° (cryoprecipitate)
MA (maximum amplitude)	54-72 mm	<54 mm (platelets)
LY-30 (lysis at 30 min)	0-7.5%	>5% (tranexamic acid)

Values in the table are for citrated rapid TEG whole blood samples. Note: A study of critically injured trauma patients identified an increase in risk of massive transfusion (91% versus 30%) and death due to hemorrhage (46% versus 5%) at an LY30 of 3%, which is a much lower target than the manufacturer-provided normal upper bound of 7.5%.^[3]

TEG: thromboelastography; ACT: activated clotting time; FFP: fresh frozen plasma.

Adapted from:

Stahel PF, Moore EE, Schreier SL, et al. Transfusion strategies in postinjury coagulopathy. Curr Opin Anaesthesiol 2009; 22:289.
Einersen PM, Moore EE, Chapman MP, et al. Rapid thrombelastography thresholds for goal-directed resuscitation of patients at risk for massive transfusion. J Trauma Acute Care Surg 2017; 82:114.
Chapman MP, Moore EE, Ramos CR, et al. Fibrinolysis greater than 3% is the critical value for initiation of antifibrinolytic therapy. J Trauma Acute Care Surg 2013; 75:961.

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Thromboelastography-guided transfusion parameters