Evaluating the Prognostic Role of Baseline Thromboelastography for Early Thrombohemorrhagic Events in Patients With Acute Leukemia
Year: 2026
Type: article
Study design: Observational Study
Abstract: Introduction Patients with newly diagnosed acute leukemia (AL) are at high risk of both bleeding and thrombotic complications, which are major causes of early morbimortality. Conventional coagulation tests have limited ability to predict these events, as they assess isolated components of hemostasis. Thromboelastography (TEG) provides a global assessment of clot formation and stability and may improve thrombohemorrhagic risk stratification in the setting of AL. Objectives To evaluate whether baseline TEG parameters are associated with early thrombohemorrhagic complications in patients with newly diagnosed AL. Methodology This was a prospective observational cohort in adults with newly diagnosed AL (AML, APL or ALL) treated at a single tertiary center in Brazil between 2018 and 2020. TEG was performed with TEG® 5000 system (Haemonetics Corp), and Coagulation Index (CI) was calculated based on TEG parameters. Bleeding and thrombotic events up to 30 days from diagnosis were assessed, and graded according to the International Society on Thrombosis and Haemostasis criteria. Early death was defined as death within the first 30 days from diagnosis. Comparison between groups were made with Mann Whitney, Kruskal Wallis and Fisher’s exact test. Associations between baseline clinical, laboratory, and TEG variables with clinical outcomes were evaluated using univariate and multivariable logistic regression analyses. Results Sixty three patients were included. Bleeding occurred in 33 patients (52.4%). 27 events occurred within the first seven days,18.5% being major hemorrhages, all in central nervous system or lungs. Thrombotic events occurred in 13 patients (20.6%), none of which were fatal. Early death rate was 19%. Most patients (58.5%) exhibited a hypocoagulable TEG profile based on CI calculation. R and K times were prolonged in 16% and 47% of the cohort, respectively; alpha angle was reduced in 37.5%, and maximum amplitude (MA) was below reference range in 75%. Patients with bleeding events showed significantly lower platelet counts and fibrinogen levels, higher D-dimer, prolonged K time (5.20 vs. 2.20 min, p = 0.01), lower alpha angle (41.9° vs. 59.9°, p = 0.005), lower MA values (37.6 vs. 49.9 mm, p = 0.003) and lower CI (-2.58 vs. -7.31, p = 0.007). In univariate analysis, fibrinogen, K time, alpha angle, MA and CI were associated with bleeding. After adjustment for platelet count and fibrinogen levels, no TEG parameter remained independently predictive of bleeding in multivariable analysis. However, a higher peripheral blast percentage was associated with early bleeding (OR 1.037, 95% CI 1.005–1.070; p = 0.023). No parameters independently predicted thrombosis or early death. Discussion and conclusion Baseline TEG demonstrated a predominantly hypocoagulable profile in AL patients, with impaired clot formation parameters among patients who experienced hemorrhages. However, its predictive value was attenuated after adjustment for established bleeding markers (platelets and fibrinogen). This might indicate that baseline TEG alone is insufficient for thrombohemorrhagic risk stratification, which could be improved by incorporating complementary biomarkers, such as thrombin generation or platelet function tests. The independent association between peripheral blast burden and early bleeding suggests that leukemia-related biological mechanisms play a major role in hemorrhagic risk in AL, and further studies analyzing this correlation are warranted.
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223129694