{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T20:21:22Z","timestamp":1772137282205,"version":"3.50.1"},"reference-count":56,"publisher":"Georg Thieme Verlag KG","issue":"07","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Thromb Hemost"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Acute ischemic stroke (AIS) due to cerebral artery occlusion is often treated by thrombolytics or antithrombotic drugs. Thromboelastography (TEG) is a noninvasive test that provides a dynamic overview of the coagulation process. TEG may help guide thrombolytic and antithrombotic therapy in AIS. This article aims to highlight the potential use of TEG in AIS patients by reviewing available studies. We conducted a literature review, including PubMed and Cochrane library databases. The following keywords were used to find relevant studies: thromboelastography, TEG, acute ischemic stroke, stroke, coagulopathy, antiplatelet, and anticoagulant treatment. We identified 142 papers and after abstract review, we included 24 studies in this report. TEG identified a hypercoagulable state in AIS patients represented by short R, K, and greater \u03b1 angle in all papers included. Modification of TEG parameters induced by intravenous thrombolysis was inconsistent but prolonged lysis (increased LY30) and weaker clots (lower maximum amplitude) were most frequent. TEG detected hypo-coagulopathy induced by dual antiplatelet therapy as well as antiplatelet drug resistance, with ticagrelor and aspirin having greater inhibition of platelet activity. A prolonged R-value seems to be the most reliable TEG parameter in detecting the anticoagulant effect of factor Xa inhibitor treatment. TEG might represent a useful point-of-care test for emergency decision-making in AIS patients and a tool for individualized treatment options. This hypothesis needs validation in a large cohort of prospectively studied AIS patients.<\/jats:p>","DOI":"10.1055\/s-0042-1753529","type":"journal-article","created":{"date-parts":[[2022,9,2]],"date-time":"2022-09-02T22:50:01Z","timestamp":1662159001000},"page":"842-849","source":"Crossref","is-referenced-by-count":9,"title":["The Applicability of Thromboelastography in Acute Ischemic Stroke: A Literature Review"],"prefix":"10.1055","volume":"48","author":[{"given":"Bianca O.","family":"P\u00eerlog","sequence":"additional","affiliation":[{"name":"Department of Neurology, County Emergency Hospital, Cluj-Napoca, Romania"},{"name":"University of Medicine and Pharmacy \u201cIuliu Ha\u021bieganu\u201d Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James C.","family":"Grotta","sequence":"additional","affiliation":[{"name":"Memorial Hermann Hospital\u2013Texas Medical Center, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,9,2]]},"reference":[{"issue":"09","key":"ref1","doi-asserted-by":"crossref","first-page":"e139","DOI":"10.1161\/CIR.0000000000000757","article-title":"Heart Disease and Stroke Statistics\u20142020 Update: a report from the American Heart Association","volume":"141","author":"S S Virani","year":"2020","journal-title":"Circulation"},{"issue":"23","key":"ref2","doi-asserted-by":"crossref","first-page":"e2292","DOI":"10.1212\/WNL.0000000000012943","article-title":"Acute ischemic stroke interventions in the United States and racial, socioeconomic, and geographic disparities","volume":"97","author":"A de Havenon","year":"2021","journal-title":"Neurology"},{"issue":"07","key":"ref3","doi-asserted-by":"crossref","first-page":"e364","DOI":"10.1161\/STR.0000000000000375","article-title":"2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association\/American Stroke Association","volume":"52","author":"D O Kleindorfer","year":"2021","journal-title":"Stroke"},{"issue":"09","key":"ref4","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1002\/phar.2158","article-title":"Trends and variation in oral anticoagulant choice in patients with atrial fibrillation, 2010-2017","volume":"38","author":"J Zhu","year":"2018","journal-title":"Pharmacotherapy"},{"issue":"13","key":"ref5","doi-asserted-by":"crossref","first-page":"e017559","DOI":"10.1161\/JAHA.120.017559","article-title":"Direct oral anticoagulant use: a practical guide to common clinical challenges","volume":"9","author":"A Chen","year":"2020","journal-title":"J Am Heart Assoc"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1007\/s11239-019-01813-0","article-title":"\u201cBlueprinting\u201d thrombogenicity and antithrombotic drug response at the bedside in patients presenting emergently with symptoms of acute stroke","volume":"47","author":"K P Bliden","year":"2019","journal-title":"J Thromb Thrombolysis"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.jemermed.2020.04.009","article-title":"Tracing the lines: a review of viscoelastography for emergency medicine clinicians","volume":"59","author":"B W Gilbert","year":"2020","journal-title":"J Emerg Med"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.annemergmed.2020.07.026","article-title":"New uses for thromboelastography and other forms of viscoelastic monitoring in the emergency department: a narrative review","volume":"77","author":"P D Tyler","year":"2021","journal-title":"Ann Emerg Med"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.ajem.2021.01.034","article-title":"Utilization of lysis percentage via thromboelastography for tissue plasminogen activator-induced symptomatic intracranial hemorrhage","volume":"43","author":"B W Gilbert","year":"2021","journal-title":"Am J Emerg Med"},{"issue":"10","key":"ref10","doi-asserted-by":"crossref","first-page":"e19447","DOI":"10.1097\/MD.0000000000019447","article-title":"Comparison between thromboelastography and the conventional coagulation test in detecting effects of antiplatelet agents after endovascular treatments in acute ischemic stroke patients: a STROBE-compliant study","volume":"99","author":"C Liang","year":"2020","journal-title":"Medicine (Baltimore)"},{"issue":"06","key":"ref11","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1007\/s13760-020-01456-6","article-title":"Efficacy of using thromboelastography to detect coagulation function and platelet function in patients with acute cerebral infarction","volume":"121","author":"Q Yuan","year":"2021","journal-title":"Acta Neurol Belg"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"9","DOI":"10.18700\/jnc.190086","article-title":"Assessment and management of coagulopathy in neurocritical care","volume":"12","author":"A M Salem","year":"2019","journal-title":"J Neurocritical Care"},{"issue":"05","key":"ref13","doi-asserted-by":"crossref","first-page":"5407","DOI":"10.21037\/apm-21-822","article-title":"Value of thromboelastography combined with anticoagulant detection in patients over 60 years of age with cardiovascular or cerebrovascular disease","volume":"10","author":"F Zhao","year":"2021","journal-title":"Ann Palliat Med"},{"issue":"03","key":"ref14","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1093\/bja\/69.3.307","article-title":"Thrombelastography","volume":"69","author":"S V Mallett","year":"1992","journal-title":"Br J Anaesth"},{"issue":"07","key":"ref15","doi-asserted-by":"crossref","first-page":"642","DOI":"10.3109\/09537104.2016.1153617","article-title":"First report of the point-of-care TEG: a technical validation study of the TEG-6S system","volume":"27","author":"P A Gurbel","year":"2016","journal-title":"Platelets"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.3390\/ijms23031043","article-title":"The importance of platelets response during antiplatelet treatment after ischemic stroke-between benefit and risk: a systematic review","volume":"23","author":"J Sikora","year":"2022","journal-title":"Int J Mol Sci"},{"issue":"04","key":"ref17","doi-asserted-by":"crossref","first-page":"569","DOI":"10.5858\/arpa.2016-0088-OA","article-title":"New-generation thromboelastography: comprehensive evaluation of citrated and heparinized blood sample storage effect on clot-forming variables","volume":"141","author":"J D Dias","year":"2017","journal-title":"Arch Pathol Lab Med"},{"issue":"04","key":"ref18","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1097\/TA.0000000000002037","article-title":"Citrated kaolin thrombelastography (TEG) thresholds for goal-directed therapy in injured patients receiving massive transfusion","volume":"85","author":"G R Stettler","year":"2018","journal-title":"J Trauma Acute Care Surg"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1097\/TA.0000000000001270","article-title":"Rapid thrombelastography thresholds for goal-directed resuscitation of patients at risk for massive transfusion","volume":"82","author":"P M Einersen","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"issue":"10","key":"ref20","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1111\/j.1365-2044.2012.07231.x","article-title":"Platelet mapping as part of modified thromboelastography (TEG\u00ae) in patients undergoing cardiac surgery and cardiopulmonary bypass","volume":"67","author":"N S Weitzel","year":"2012","journal-title":"Anaesthesia"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"143","DOI":"10.3390\/diagnostics11010143","article-title":"Viscoelastic hemostatic assays and platelet function testing in patients with atherosclerotic vascular diseases","volume":"11","author":"M Samo\u0161","year":"2021","journal-title":"Diagnostics (Basel)"},{"issue":"02","key":"ref22","first-page":"CD010438","article-title":"Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) for trauma induced coagulopathy in adult trauma patients with bleeding","author":"H Hunt","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"issue":"04","key":"ref23","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1080\/09537104.2021.1961709","article-title":"The role of viscoelastic testing in assessing peri-interventional platelet function and coagulation","volume":"33","author":"U S Tantry","year":"2022","journal-title":"Platelets"},{"issue":"03","key":"ref24","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1111\/anae.14542","article-title":"A comparison of the new ROTEM\u00ae sigma with its predecessor, the ROTEMdelta","volume":"74","author":"B Schenk","year":"2019","journal-title":"Anaesthesia"},{"issue":"03","key":"ref25","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1161\/01.STR.5.3.350","article-title":"Thromboelastographic studies in cerebral infarction","volume":"5","author":"M G Ettinger","year":"1974","journal-title":"Stroke"},{"issue":"02","key":"ref26","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1111\/j.1747-4949.2012.00919.x","article-title":"Thromboelastography in patients with acute ischemic stroke","volume":"10","author":"A Elliott","year":"2015","journal-title":"Int J Stroke"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"6466","DOI":"10.12659\/MSM.910121","article-title":"Comparison of thrombelastography (TEG) in patients with acute cerebral hemorrhage and cerebral infarction","volume":"24","author":"Z Liu","year":"2018","journal-title":"Med Sci Monit"},{"key":"ref28","first-page":"125","article-title":"Hypercoagulation on thromboelastography predicts early neurological deterioration in patients with acute ischemic stroke","volume":"46","author":"Z Shi","year":"2018","journal-title":"Cerebrovasc Dis"},{"issue":"09","key":"ref29","doi-asserted-by":"crossref","first-page":"1772","DOI":"10.1016\/j.ajem.2020.05.052","article-title":"Thromboelastography for prediction of hemorrhagic transformation in patients with acute ischemic stroke","volume":"38","author":"G Yu","year":"2020","journal-title":"Am J Emerg Med"},{"issue":"03","key":"ref30","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1159\/000365652","article-title":"Thrombelastography maximal clot strength could predict one-year functional outcome in patients with ischemic stroke","volume":"38","author":"X Yao","year":"2014","journal-title":"Cerebrovasc Dis"},{"issue":"11","key":"ref31","doi-asserted-by":"crossref","first-page":"104336","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.104336","article-title":"Unstable carotid plaque is associated with coagulation function and platelet activity evaluated by thrombelastography","volume":"28","author":"J Li","year":"2019","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"03","key":"ref32","first-page":"301","article-title":"Clot strength as measured by thrombelastography correlates with platelet reactivity in stroke patients","volume":"45","author":"R SP Huang","year":"2015","journal-title":"Ann Clin Lab Sci"},{"issue":"06","key":"ref33","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1016\/j.jstrokecerebrovasdis.2013.11.001","article-title":"Thromboelastographic changes in patients experiencing an acute ischemic stroke and receiving alteplase","volume":"23","author":"A S Rowe","year":"2014","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"03","key":"ref34","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1007\/s11239-015-1280-9","article-title":"Thrombelastography does not predict clinical response to rtPA for acute ischemic stroke","volume":"41","author":"M M McDonald","year":"2016","journal-title":"J Thromb Thrombolysis"},{"issue":"02","key":"ref35","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1161\/STROKEAHA.113.003268","article-title":"Iodinated contrast does not alter clotting dynamics in acute ischemic stroke as measured by thromboelastography","volume":"45","author":"M M McDonald","year":"2014","journal-title":"Stroke"},{"issue":"01","key":"ref36","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1177\/0885066617729644","article-title":"Dual antiplatelet therapy is associated with coagulopathy detectable by thrombelastography in acute stroke","volume":"35","author":"M M McDonald","year":"2020","journal-title":"J Intensive Care Med"},{"issue":"07","key":"ref37","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1136\/neurintsurg-2021-017615","article-title":"Thromboelastography predicts dual antiplatelet therapy-related hemorrhage in patients with acute ischemic stroke","volume":"14","author":"D He","year":"2022","journal-title":"J Neurointerv Surg"},{"issue":"03","key":"ref38","doi-asserted-by":"crossref","first-page":"210","DOI":"10.3109\/09537104.2010.543201","article-title":"\u201cShort\u201d thrombelastography as a test of platelet reactivity in response to antiplatelet therapy: validation and reproducibility","volume":"22","author":"N Sambu","year":"2011","journal-title":"Platelets"},{"issue":"07","key":"ref39","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1080\/09537100701329162","article-title":"A novel fifteen minute test for assessment of individual time-dependent clotting responses to aspirin and clopidogrel using modified thrombelastography","volume":"18","author":"A R Hobson","year":"2007","journal-title":"Platelets"},{"issue":"01","key":"ref40","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1177\/147323001204000128","article-title":"Aspirin resistance: clinical significance and genetic polymorphism","volume":"40","author":"Z H Xu","year":"2012","journal-title":"J Int Med Res"},{"issue":"08","key":"ref41","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1016\/j.jstrokecerebrovasdis.2013.05.031","article-title":"\u201cAspirin resistance\u201d in ischemic stroke: insights using short thrombelastography","volume":"22","author":"N Sambu","year":"2013","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"05","key":"ref42","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1160\/TH12-10-0758","article-title":"High on-treatment platelet reactivity\u2013definition and measurement","volume":"109","author":"M Cattaneo","year":"2013","journal-title":"Thromb Haemost"},{"issue":"10","key":"ref43","doi-asserted-by":"crossref","first-page":"2074","DOI":"10.1016\/j.jstrokecerebrovasdis.2017.04.012","article-title":"High on-treatment platelet reactivity to adenosine diphosphate predicts ischemic events of minor stroke and transient ischemic attack","volume":"26","author":"Z Rao","year":"2017","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"02","key":"ref44","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1136\/neurintsurg-2015-011687","article-title":"Association of thrombelastographic parameters with post-stenting ischemic events","volume":"9","author":"B Wang","year":"2017","journal-title":"J Neurointerv Surg"},{"issue":"20","key":"ref45","doi-asserted-by":"crossref","first-page":"20085","DOI":"10.18632\/aging.103452","article-title":"Effect of ticagrelor versus clopidogrel on platelet reactivity measured by thrombelastography in patients with minor stroke or TIA","volume":"12","author":"Y Yang","year":"2020","journal-title":"Aging (Albany NY)"},{"issue":"03","key":"ref46","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1161\/STROKEAHA.113.004016","article-title":"Thrombelastography detects the anticoagulant effect of rivaroxaban in patients with stroke","volume":"45","author":"R Bowry","year":"2014","journal-title":"Stroke"},{"issue":"05","key":"ref47","doi-asserted-by":"crossref","first-page":"665","DOI":"10.5858\/arpa.2014-0170-OA","article-title":"Use of thromboelastography (TEG) for detection of new oral anticoagulants","volume":"139","author":"J D Dias","year":"2015","journal-title":"Arch Pathol Lab Med"},{"issue":"03","key":"ref48","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1002\/rth2.12206","article-title":"Fully automated thromboelastograph TEG 6s to measure anticoagulant effects of direct oral anticoagulants in healthy male volunteers","volume":"3","author":"R Artang","year":"2019","journal-title":"Res Pract Thromb Haemost"},{"issue":"04","key":"ref49","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1007\/s11239-017-1477-1","article-title":"Determination of non-Vitamin K oral anticoagulant (NOAC) effects using a new-generation thrombelastography TEG 6s system","volume":"43","author":"K P Bliden","year":"2017","journal-title":"J Thromb Thrombolysis"},{"issue":"05","key":"ref50","first-page":"577","article-title":"The relationship between thromboelastography and clinical outcome in acute stroke patients receiving thrombolytic therapy","volume":"42","author":"E \u00d6zakin","year":"2020","journal-title":"Osman T\u0131p Derg"},{"issue":"05","key":"ref51","doi-asserted-by":"crossref","first-page":"493","DOI":"10.5551\/jat.32748","article-title":"Novel diagnostic and monitoring tools in stroke: an individualized patient-centered precision medicine approach","volume":"23","author":"S de Villiers","year":"2016","journal-title":"J Atheroscler Thromb"},{"issue":"02","key":"ref52","doi-asserted-by":"crossref","first-page":"e29","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.10.039","article-title":"Usefulness of thromboelastography in the detection and management of tissue plasminogen activator-associated hyperfibrinolysis","volume":"26","author":"F Rosafio","year":"2017","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"06","key":"ref53","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1160\/TH15-10-0798","article-title":"Thromboelastometry profiles in patients undergoing thrombolytic therapy for acute ischaemic stroke","volume":"115","author":"E Campello","year":"2016","journal-title":"Thromb Haemost"},{"key":"ref54","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.jocn.2020.06.004","article-title":"A comparison of three platelet function tests in ischemic stroke patients with antiplatelet therapy","volume":"78","author":"T Shao","year":"2020","journal-title":"J Clin Neurosci"},{"issue":"02","key":"ref55","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s11239-019-01956-0","article-title":"Global thromboelastometry in patients receiving direct oral anticoagulants: the RO-DOA study","volume":"49","author":"M C Vedovati","year":"2020","journal-title":"J Thromb Thrombolysis"},{"issue":"01","key":"ref56","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/s12959-021-00313-7","article-title":"Point-of-care detection and differentiation of anticoagulant therapy - development of thromboelastometry-guided decision-making support algorithms","volume":"19","author":"S T Sch\u00e4fer","year":"2021","journal-title":"Thromb J"}],"container-title":["Seminars in Thrombosis and Hemostasis"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0042-1753529.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,19]],"date-time":"2022-10-19T00:16:58Z","timestamp":1666138618000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0042-1753529"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,2]]},"references-count":56,"journal-issue":{"issue":"07","published-online":{"date-parts":[[2022,10,18]]},"published-print":{"date-parts":[[2022,10]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0042-1753529","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0094-6176","1098-9064"],"issn-type":[{"value":"0094-6176","type":"print"},{"value":"1098-9064","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,2]]}}}