Cardiopulmonary bypass (CPB) coagulopathy increases utilization of allogenic blood/blood products, which can negatively affect patient outcomes. Thromboelastography (TEG) is a point-of-care measurement of clot formation and fibrinolysis. We investigated whether the addition of TEG parameters to a clinically based bleeding model would improve the predictability of postoperative bleeding. A total of 439 patients’ charts were retrospectively investigated for 8-h chest tube output (CTO) postoperatively. For model 1, the variables recorded were patient age, gender, body surface area, clopidogrel use, CPB time, first post-CPB fibrinogen serum level, first post-CPB platelet count, first post-CPB international normalized ratio, the total amount of intraoperative cell saver blood transfused, and postoperative first ICU hematocrit level. Model 2 had the model 1 variables, TEG angle, and maximum amplitude. The outcome was defined as 0–8-h CTO. The predictor variables were placed into a forward stepwise regression model for continuous outcomes. Analysis of variance with adjusted R2 was used to assess the goodness-of-fit of both predictive models. The predictive accuracy of the model was examined using CTO as a dichotomous variable (75th percentile, 480 ml) and receiver operating characteristic curves for both models. Advanced age, male gender, preoperative clopidogrel use for 5 days or less, greater cell saver blood utilization, and lower postoperative hematocrit levels were associated with increased 8-h CTO (P < 0.05). Adding TEG angle and maximum amplitude to model 1 did not improve CTO predictability. When TEG angle and maximum amplitude were added as predictor factors, the predictability of the bleeding model did not improve.
Background and objectives Prior to 2008, when it was withdrawn, aprotinin use in cardiac surgery patients was associated with reduced bleeding and blood utilization, but studies linked its administration to increased patient mortality. We investigated (a) blood/blood product utilization between 2008 and 2013 at our community hospital heart center according to the type of surgery performed following the withdrawal of aprotinin and (b) clinical variables associated with increased patient blood utilization. Materials and methods Seven hundred nine patients were retrospectively investigated for blood/blood product utilization. Variables examined were patient age, body surface area (BSA), gender, preoperative creatinine level, hematocrit level, total cell saved blood (CSB) administered, cardiopulmonary bypass (CPB) time, type of surgical procedure performed, and preoperative clopidogrel usage. Variables (categorical and continuous) were placed into a forward stepwise regression model for the continuous outcome, packed red blood cell (PRBC) utilization. The stepwise function utilized a P value threshold of 0.25 for entering the model and 0.1 for leaving the model. Results For coronary artery bypass graft (CABG) surgery, use of PRBC was 29.26 % (0.75/1.44), of platelets was 14.18 % (0.24/0.72), of fresh frozen plasma (FFP) was 7.34 % (0.19/ 0.78), and of cryoprecipitate was 10.63 % (0.23/0.97) among our patient sample. [Data expressed as percent patient utilization, mean/S.D. in units transfused]. Increased age, smaller BSA, higher preoperative creatinine level, lower preoperative hematocrit level, longer CPB time, and increased CSB administration was associated with increased PRBC administration (P < 0.0001). Conclusion At our community heart surgery center, with a multidisciplinary blood conservation program in place, expected increase in blood/blood product utilization following aprotinin withdrawal was not experienced.
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