Approach to thromboelastography-based transfusion in cirrhosis: An alternative perspective on coagulation disorders

Table 2 Thromboelastography components and their clinical implications

Nomenclature	Definition	Function	Significance	Most closely related CCT
Reaction time or R-time	Time (min) to reach an amplitude of 2 mm	Clot initiation	Informs about enzymatic reaction leading to thrombin and fibrin generation. Increased R-time, factor deficiency or reduced function, resulting in hypocoagulability; Shortened R-time, factor hypercoagulability	PT and aPTT
K-time	Time (min) from 2-20 mm amplitude	Clot kinetics	Depicts rate of clot development–fibrin polymerization, cross-linking, and platelet interaction. Long K-time, hypocoagulability; Short K-time, hypercoagulability	Fibrinogen level and platelet count
Angle or α	Slope between R and K	Clot kinetics	Also depicts the kinetics of clot development. Low-angle, hypocoagulability; High-angle, hypercoagulability
MA	Highest level of amplitude achieved by the clot	Clot strength	Provides assessment of overall clot strength	Platelet count and fibrinogen levels
Coagulation index	Composite indicator of coagulation profile		A linear combination of the above parameters serving as a global view of the patient’s hemostatic profile. Increased in hypercoagulable states; Decreased in hypocoagulable states
LY30	Degree of lysis (%) 30 min after MA is reached	Clot stability	Measure of fibrinolysis. Above normal LY30 suggests hyperfibrinolysis	No equivalent test

aPTT: Activated partial thromboplastin time; CCT: Conventional coagulation test; MA: Maximum amplitude; PT: Prothrombin time.