coagulation

TEG 6s Coagulation Guide

Interpret thromboelastography (TEG 6s) results and identify targeted coagulation therapy. Differentiate heparin effect from factor deficiency and guide goal-directed hemostatic management.

Based on: ESC 2022 · ESAIC

Input

Baseline assessment. All 5 parameters: CK-R, CKH-R, CRT-MA, CFF-MA, LY30. CK-R / CKH-R comparison differentiates heparin effect from factor deficiency.


Clot InitiationCK-R · CKH-R

Citrated Kaolin R time (heparin-sensitive; varies before/after protamine)

Citrated Kaolin + Heparinase R time (neutralises heparin; reflects true factor activity)

Clot FirmnessCRT-MA · CFF-MA

Citrated Rapid TEG maximum amplitude (combined platelet + fibrinogen clot strength)

Citrated Functional Fibrinogen MA (platelet contribution blocked; reflects fibrinogen only)

FibrinolysisLY30

Lysis at 30 min (percentage clot dissolved 30 min after MA; higher = more fibrinolysis)

Overview

Thromboelastography (TEG 6s) provides real-time viscoelastic assessment of whole-blood coagulation at the bedside. By measuring clot formation continuously, TEG captures the entire haemostatic process — from initial thrombin generation through clot strength and fibrinolysis. This tool focuses on five key TEG 6s parameters — CK-R, CKH-R, CRT-MA, CFF-MA, and LY30 — which together map the major physiological phases of haemostasis: clot initiation, clot strength, and fibrinolysis.

Evidence Summary

Multiple randomised trials and meta-analyses demonstrate that viscoelastic haemostatic assay (VHA)-guided transfusion reduces allogeneic blood product use without increasing mortality or thromboembolic events. Evidence is strongest in cardiac surgery and trauma haemorrhage. ITACTIC (2021) compared VHA-augmented protocols with conventional coagulation tests in trauma: while the primary endpoint was not met in the overall population, VHA protocols reduced 24-hour blood product use. A 2015 Cochrane review (Whiting et al.) confirmed that point-of-care viscoelastic testing reduces red cell transfusion compared with standard laboratory tests. Compared with PT/APTT/fibrinogen, TEG provides faster turnaround and reflects global haemostatic function under near-physiological conditions.

Learn More

Learn the coagulation patterns

Review how CK, CKH, CRT, CFF, MA, and LY30 map to clot initiation, clot strength, platelet contribution, fibrinogen contribution, and fibrinolysis. Use the education guide to connect each parameter to a hemostatic target.

Open Coagulation Education