Analysis of thromboelastogram on coagulation and fibrinolysis

Abstract

Hartert’s thromboelastography has been used in the diagnosis of abnormal blood clotting for more than 20 years. From a thromboelastogram three parameters are obtained, viz, the reaction time ‘r’, the rate of formation of fibrin clot ‘k’ , the maximum elasticity of thrombus ‘a_max’. It is desirable, however, to know the equation that describes the thromboelastogram both in the period in which the complex modulus increases with time because of coagulation, and in the period in which the complex modulus decreases with time because of fibrinolysis. The parameters of the equation could then be used as a diagnostic criterion; yielding information on the mechanism of coagulation and fibrinolysis. Based on our experimental results on human blood in normal and abnormal subjects, we found that the complex modulus of thromboelastograms can be expressed by the sum of two terms, one describing the increase of the complex modulus during coagulation, ${\mathrm{G}}_1={\mathrm{G}}_1^{\prime }\mathrm{(}-{\mathit{\tau }}_1\mathrm{/}\mathrm{t}\mathrm{)}$ , the other describing the decrease of the complex modulus during fibrinolysis, ${\mathrm{G}}_2={\mathrm{G}}_2^{\prime }\mathrm{(}-{\mathit{\tau }}_2\mathrm{/}\mathrm{t}-\mathrm{D}\mathrm{)}$ when t > D. G₂ = 0 when t < D. The compound complex modulus from coagulation to fibrinolysis is $\mathrm{G}={\mathrm{G}}_1-{\mathrm{G}}_2$ . Here t is the clotting time, and ${\mathrm{G}}_1^{\prime }$ , ${\mathrm{G}}_2^{\prime }$ , ${\mathit{\tau }}_1$ , ${\mathit{\tau }}_2$ , and D are five constants to be identified. These five constants can be used for diagnostic and prognostic purposes.