High CFF MA on TEG Indicates Hypercoagulability

Understanding CFF MA

Maximum Amplitude (MA) represents the maximum strength of the clot and primarily reflects fibrinogen contribution when measured on the CFF assay, according to the American College of Cardiology 1
The CFF test uses a platelet inhibitor to isolate fibrinogen's contribution to clot strength, distinguishing it from platelet-mediated clot firmness, as reported by the International Society on Thrombosis and Haemostasis 2
Normal MA values typically range from 50-70 mm, though specific reference ranges vary by device and clinical context, as stated by the American College of Cardiology 3
Increased MA indicates hypercoagulability, which correlates with enhanced thrombotic risk, according to the American Heart Association 1

High CFF MA reflects elevated fibrinogen levels and predicts increased risk for thrombotic events, as reported by the American College of Cardiology 1
Pregnancy naturally increases MA values due to physiologic hypercoagulability, with progressive increases throughout gestation, according to the International Society on Thrombosis and Haemostasis 4, 5

For severe hypercoagulability with high thrombotic risk, consider therapeutic anticoagulation with low molecular weight heparin (LMWH), particularly in pregnant patients where LMWH is preferred over unfractionated heparin, as recommended by the American College of Obstetricians and Gynecologists 1
In pregnancy, 40 mg enoxaparin demonstrates greater anticoagulant effect than 7500 IU unfractionated heparin, with 73% of patients becoming hypocoagulable versus only 47% with UFH, according to the American College of Cardiology 1
The anticoagulant effect on TEG is defined as a difference >25% between plain and heparinase R time samples, as reported by the International Society on Thrombosis and Haemostasis 4, 5

Mild preeclampsia patients are more hypercoagulable than healthy pregnant women, but as severity worsens, coagulability paradoxically decreases, particularly when platelet counts fall below 100,000/mm³, according to the American College of Obstetricians and Gynecologists 4
Women with VTE risk factors post-delivery maintain similar postpartum hypercoagulability patterns regardless of delivery mode, as reported by the International Society on Thrombosis and Haemostasis 5
Higher fibrinogen targets (>2.0 g/L) may be needed in obstetric hemorrhage management, as stated by the American College of Cardiology 3

Increasing BMI shows a trend toward greater hypercoagulability, though the hypercoagulable effect of term pregnancy appears greater in magnitude than obesity alone, according to the International Society on Thrombosis and Haemostasis 5

Anemia can paradoxically show hypercoagulable TEG results (including elevated MA) due to decreased blood viscosity, potentially masking true coagulopathy or exaggerating hypercoagulability, as reported by the American College of Cardiology 1, 3
TEG shows high coefficients of variance (7.1-39.9% for TEG parameters), requiring interpretation in clinical context, according to the American College of Cardiology 1
Results are not interchangeable between TEG and ROTEM devices—CFF MA values differ significantly from FIBTEM MCF values even at identical fibrinogen concentrations, as stated by the American College of Cardiology 1

Repeat TEG 15-30 minutes after any anticoagulation intervention to assess response, as recommended by the American College of Cardiology 1