Viscoelastic haemostatic assay (TEG/ROTEM) is used perioperatively. A patient has prolonged R-time/CT (clotting time) with normal alpha angle and MA. What does this pattern indicate and what is the appropriate treatment?

• A Fibrinogen deficiency; treat with cryoprecipitate or fibrinogen concentrate
• B Platelet dysfunction; treat with platelet transfusion
• C Hyperfibrinolysis; treat with tranexamic acid
• D Clotting factor deficiency or anticoagulant effect; treat with FFP or specific factor concentrate ✓

Explanation

In TEG/ROTEM, the R-time (TEG) or CT (ROTEM) reflects the time to initial clot formation, which is dependent on the coagulation cascade factors. Prolonged R-time/CT with normal alpha angle (fibrinogen function) and normal MA (platelet function) specifically indicates a factor deficiency or the presence of an anticoagulant drug. Treatment is FFP or specific factor concentrates. A prolonged alpha angle or low MA suggests fibrinogen or platelet issues respectively, while decreased LY30 or EPL indicates fibrinolysis.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.