PDF (Українська)


hemophilia, prophylaxis, thromboelastography, correlation

How to Cite

V. V. Krasivska, O. V. Stasyshyn, M. M. Semerak, O. M. Tushnytskyi, & V. L. Novak. (2019). CORRELATION OF THE PARAMETERS OF THROMBO-ELASTOGRAM WITH THE RESULTS OF COAGULATIOIN TESTS IN HAEMOPHILIA A PATIENTS DURING PROPHYLAXIS. Eastern Ukrainian Medical Journal, 7(3), 215-225. Retrieved from


Background: In order to control the treatment of haemophilia patients, classical coagulation methods (APTT, FVIII (IX)) and global tests are used. One of the tests for a comprehensive coagulation assessment is thromboelastography (TEG), which can provide immediate results and reflect the hemostatic status of the patient during therapy. Some of the parameters obtained from the TEG can be compared with the coagulation tests since they describe similar processes of coagulation.

Purpose: To carry out a correlation analysis of TEG parameters with coagulation test parameters to determine the role of TEG in the control of prophylactic treatment and the development of inhibitors in patients with severe haemophilia A.

Materials and methods: 9 haemophilia A patients were treated with 45 ± 5 IU/kg of FVIII of body weight twice a week prophylactically an incremental recovery test (IR) at a dose of 60 ± 5 IU/kg body weight was performed. Prior to and after administration, TEG was performed and the PT, APTT, fibrinogen, FVIII, FVIII:Ag, vWF:Ag and the platelet count were measured. The possible dependencies of 10 TEG parameters (R, K, α-Angle, MA, TMA, SI, SP, G, LY30, TPI/c) and coagulation tests results were analyzed.

Results: Significant direct correlation of the R and SP on the PT and APTT was found (r > 0.71) prior to the administration of the FVIII concentrate. The negative average correlation between R and FVIII:Ag (r = ‑0.56) was established. The elongation of the PT and APTT and the decrease in the activity of FVIII:Ag causes a decrease in the total hemostatic potential of the SI in the direction of hypocoagulation (r = 0.75). Prior to administration of the calculated dose, the concentration of MA, TMA and α-Angel inclination strongly and directly depends on the level of vWF:Ag and platelet count (in all cases r > 0.7). After administration of the FVIII concentrate in haemophilia A patients, a significant positive correlation between the response time R and the APTT (r = 0.64) was found. The growth of the CІ coagulation index is associated with an increase in the level of FVIII: Ag (r = 0.75) and a shortening of the APTT (r = -0.76). Other dependencies between TEG parameters and hemostatic tests have not been established.

Conclusion: Correlation of TEG parameters and results of traditional coagulation tests characterized similar processes of coagulation and was revealed in haemophilia A patients on prophylactic treatment. For R, SI, SP depending on the values of the PT, APTT, FVIII: Ag, the end point is coagulation. MA, TMA, α-Angel depend on the level of vWF: Ag and platelet count which reflects the initiation of haemostasis and the strength of clot. TEG fully reflects the changes in hemostasis, so thromboelastography can be successfully applied to control the treatment and the development of FVIII (IX) inhibitors in hemophilia patients.

PDF (Українська)


1. Ahnström J, Berntorp E, Lindvall K, Bjorkman S. A 6-year follow-up of dosing, coagulation factor levels and bleedings in relation to joint status in the prophylactic treatment of haemophilia. Haemophilia. 2004;10(6):689–97.
2. Roberts HR, Hoffman M, Monroe DM. A cell-based model of thrombin generation. Semin. Thromb. Hemost. 2006;32(1):32-8.
3. Hoffman M, Monroe DM. A cell-based model of hemostasis. Thromb. Haemost. 2001; 85(6):958–65.
4. Lancé Marcus D. A general review of major global coagulation assays: thrombelastography, thrombin generation test and clot waveform analysis. Thromb. J. 2015;13:1 – 6.
5. Verma A. Thromboelastography as a novel viscoelastic method for hemostasis monitoring: Its methodology, applications, and constraints. Glob. J. Transfus. Med. AATM. 2017;2:8–18.
6. Nair SC, Dargaud Y, Chitlur M, Srivastava A. Tests of global haemostasis and their applications in bleeding Disorders. Haemophilia. 2010;16(5):85–92.
7. Da Luz LT, Nascimento B, Shankarakutty A K, Rizili S, Adhikari NK. Effect of thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®) on diagnosis of coagulopathy, transfusion guidance and mortality in trauma: descriptive systematic review. Crit. Care. 2014;18:518.
8. Da Luz LT, Nascimento B, Rizoli S. Thrombelastography (TEGW): practical considerations on its clinical use in trauma resuscitation. Scand. J. Trauma Resusc. Emerg. Med. 2013;21:29–36.
9. Chen GY, Ou Yang XL, Wu JH, Wang LH, Yang JH, Gu LN, Zhao XZ. Comparison of thromboelastography and routine coagulation tests for evaluation of blood coagulation function in patients. Zhongguo Shi Yan Ye Xue Za Zhi. 2015;23(2):546–51.
10. Lamoshi AY, Wilson AM. Thromboelastography parameters versus classical coagulation profile in trauma patients: Retrospective study. Niger. J. Surg. Res. 2016;17:33–7.
11. Al Hawaj M A, Martin E J, Venitz J, [et al.]. Monitoring rFVIII prophylaxis dosing using global haemostasis assays. Haemophilia. 2013;19:409–14.
12. Chitlur M, Rivard GE, Lillicrap D, Mann K, Shima M, Young G. Recommendations for performing thromboelastography/ thromboelastometry in hemophilia: communication from the SSC of the ISTH. J. Thromb. Haemost. 2014;1 2(1): 103–6.
13. Ramiz S, Hartmann J, Young G, Escobar MA, Chitlur M. Clinical utility of viscoelastic testing (TEG and ROTEM analyzers) in the management of old and new therapies for hemophilia. Am. J. Hematol. 2018; 94(2): 249–56.
14. Сollins PW, Chalmers E, Hart DP, Liesner R, Rangarajan S, Williams M, Hay CR, UK Haemophilia Centre Doctors. Diagnosis and treatment of factor VIII and IX inhibitors in congenital haemophilia: (4th ed.). Br. J. Haematol. 2013;160(2):153–70.
15. Hay CR, Brown S, Collins PW, Keeling DM, Liesner R. The diagnosis and management of factor VIII and IX inhibitors: a guideline from the United Kingdom Haemophilia Centre Doctors Organisation (UKHCDO). Br. J. Haematol. 2006;133:591–605.
16. Srivastava A, Brewer AK, Mauser-Bunschoten EP, Mauser-Bunschoten EP, Key NS, Kitchen S, Linas A, Ludlam CA, Mahlangu JN, Mulder K, Poon MC, Street A, Treatment Guidelines Working Group on Behalf of The World Federation Of Hemophilia. Guidelines for the management of hemophilia (2nd ed). Haemophilia. 2013;19(1):e1-e47.
17. Kitchen S, McCraw A. Diagnosis of haemophilia and other bleeding disorders. A laboratory manual. Montreal: World Federation of Hemophilia (WFH), 2000.108 p.
18. Kitchen S, McCraw A, Echenagucia M. Diagnosis of haemophilia and other bleeding disorders. A laboratory manual (2nd ed). Montreal: World Federation of Hemophilia (WFH), 2010.144 p.
19. Favaloro EJ, Verbruggen B, Miller CH. Laboratory testing for factor inhibitors. Haemophilia. 2014;20(4):94–8.
20. Kasper C, Aledort L, Counts R, Edson JR, Fratantoni J, Green D, Hampton JW, et al. Measurement of factor VIII inhibitors. Thromb. Diath. Hemorrh. 1975; 34:869-72.
21. Roeloffzen WWH, Kluin-Nelemans HC, Mulder AB, Veeger NJGM, Bosman L, de Wolf JThM. In Normal Controls, Both Age and Gender Affect Coagulability as Measured by Thromboelastography. Anesthesia & Analgesia. 2010;110(4):987–94.
22. Scarpelini S, Rhind SG, Nascimento B, Tien H, Shek PN, Pemg HT, Pinto R, Speers V, Reis M, Rizoli SB. Normal range values for thromboelastography in healthy adult volunteers. Braz. J. Med. Biol. Res. 2009;42(12):1210–17.
23. Rajwal S, Richards M, O’Meara M. The use of recalcified citrated whole blood – a pragmatic approach for thromboelastography in children. Pediatr. Anesth. 2004;14: 656–60.
24. Wohlauer MV, Moore EE, Harr J, Gonzalez E, Fragoso M, Siliman CC. A Standardized Technique for Performing Thrombelastography in Rodents. Shock. 2011;36(5):5.