Management of Elevated LY30 on Thromboelastography (TEG)

Understanding Elevated LY30 on TEG

Elevated LY30 indicates hyperfibrinolysis, which can destabilize effective coagulation in clinical situations such as trauma, obstetric hemorrhage, and major organ surgery, according to the American Society of Anesthesiologists 1, 3
TEG thresholds between 3% and 7.5% LY30 have been associated with increased risk for massive transfusion and mortality, as reported by the International Society on Thrombosis and Haemostasis 3
Accelerated fibrinolysis can be identified by laboratory assay of d-dimers or fibrin degradation products, or by use of coagulation monitors such as TEG or ROTEM, as stated by the American College of Cardiology 1

Tranexamic acid inhibits plasminogen activation and at high concentrations inhibits plasmin, effectively reversing established fibrinolysis, according to the American College of Critical Care Medicine 1, 2
Recommended dosing of tranexamic acid is 1g loading dose over 10 minutes followed by 1g over 8 hours, as recommended by the American College of Critical Care Medicine 1, 2

Continue to monitor TEG parameters to guide ongoing treatment, as suggested by the American Society of Anesthesiologists and the International Society on Thrombosis and Haemostasis 1, 3
Thrombolytic infusion should be stopped when values return to normal or near normal, according to the American College of Cardiology 4, 5

Tranexamic acid has been shown to reduce mortality in patients with traumatic brain injury when given within 3 hours of injury, as reported by the American College of Critical Care Medicine 2
Tranexamic acid is contraindicated in patients with subarachnoid hemorrhage, as stated by the American Society of Anesthesiologists 1

Do not rely solely on conventional coagulation tests (PT, aPTT) as they may not correlate well with clinical bleeding or TEG parameters, as warned by the American College of Critical Care Medicine and the International Society on Thrombosis and Haemostasis 2, 3
Remember that TEG may be poorly sensitive to fibrinolysis in some cases, so integrate clinical assessment with laboratory findings, as suggested by the American College of Critical Care Medicine 2
Do not delay treatment while waiting for laboratory results in cases of severe bleeding, as advised by the American College of Critical Care Medicine 2