Nabil Tabish: TEG Reveals the True Effect of Heparin During ECMO
Nabil Tabish, Regional Medical Director at Kaiser Permanente, shared a post on LinkedIn:
”This infographic visually tells the story of a patient on ECMO; we discussed, focusing on the critical difference between measuring Unfractionated heparin’s chemical concentration versus its actual, functional effect. It contrasts two very different diagnostic views of the same patient:
The Misleading Standard Labs: On one side, the plasma-based labs (the anti-Xa level of 0.38 IU/mL and PTT of 47 seconds) falsely suggested the patient was only mildly anticoagulated. These isolated tests can be highly misleading in complex scenarios like ECMO where factors like Antithrombin III are depleted.
The Accurate TEG 6s Assessment: On the other side, the design highlights the TEG 6s whole-blood functional assessment. It illustrates the stark contrast between the patient’s severely prolonged CK (Citrated Kaolin) R-time of greater than 17 minutes and their completely normal CKH (Citrated Kaolin with Heparinase) R–time of 6.9 minutes.
By visually showing how neutralizing the heparin in the CKH channel instantly corrects the delayed clotting time, there is mechanical proof that the heparin profoundly anticoagulanting the patient.
Ultimately, the piece visually reinforces the manufacturer’s guidance that diagnostic results should always be evaluated and functional assays play a superior role in complex clinical patients with a refined balance between thrombosis and anticoagulation.”
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