Comparison of two point of care whole blood coagulation analysis devices and conventional coagulation tests as a predicting tool of perioperative bleeding in adult cardiac surgery—a pilot prospective observational study in Japan

Abstract

BACKGROUND It is widely accepted that Point‐of Care Test (PoCT) devices are useful in the detection of coagulopathies in situations of massive bleeding such as major cardiac surgery. These devices contribute to the reduction of blood transfusion. However, their implementation remains limited in Japan because of their cost and lack of health insurance support. STUDY DESIGN AND METHODS Conventional coagulation tests and thromboelastography (TEG)/Sonoclot values were measured in 50 consecutive cardiac surgery cases. Clinical background information such as operative procedures was obtained from electronic medical records, and the theoretical perioperative total blood loss was calculated by measuring the hemoglobin content and total red blood cell transfusion volume. The correlation between perioperative total blood loss and the measured laboratory values or clinical parameters was evaluated by a multivariate linear regression analysis. The risk factors of the total amount of platelet transfusion and postoperative drain bleeding volume were similarly evaluated. RESULTS No significant association between the estimated perioperative total blood loss (eTBL) and the laboratory measurements including conventional coagulation tests, TEG and Sonoclot was observed. On the other hand, postoperative drain bleeding volume was significantly associated with postoperative Sonoclot CR (p = 0.039) as well as preoperative use of oral anticoagulants and cell saver treated blood volume. Platelet transfusion amount was significantly associated with post‐CBP PF and time to peak value of Sonoclot (p = 0.014 and 0.001, respectively). CONCLUSION Sonoclot measurements may be useful to estimate the risks of postoperative bleeding and platelet transfusion in cardiac surgeries in Japan.

Assessment of platelet function utilizing viscoelastic testing

“…Unfortunately, only a handful of small‐scale observational and perioperative pilot studies have focused on the clinical utility and effectiveness of Sonoclotʼs PF or Quantraʼs PCS measurements in PLT function monitoring. PLT transfusions were found to be associated with postoperative Sonoclot PF measurements in a prospective observational study, which compared TEG to Sonoclot variables in 50 consecutive cardiac surgery patients 62 . It was noted that the degree of correlation diminished after a 20 minutes delay postdraw, suggesting that such a finding would be less useful outside of an immediate POC setting.…”

“…PLT transfusions were found to be associated with postoperative Sonoclot PF measurements in a prospective observational study, which compared TEG to Sonoclot variables in 50 consecutive cardiac surgery patients. 62 It was noted that the degree of correlation diminished after a 20 minutes delay postdraw, suggesting that such a finding would be less useful outside of an immediate POC setting. Early in vitro studies found Sonoclotʼs PF poorly reproducible and highly influenced by PLT counts and modest correlation of the PF to PLT counts was noted in studies.…”

“…Early in vitro studies found Sonoclotʼs PF poorly reproducible and highly influenced by PLT counts and modest correlation of the PF to PLT counts was noted in studies. [62][63][64][65][66] Similarly, studies are needed to fully validate whether Quantraʼs PCS measures PLT function and is not simply a reflection of PLT count. An early study suggests that Quantra PCS correlates with ADP-dependent function (as demonstrated by moderate correlation to the MEA) and remained independently associated after adjusting for PLT count.…”

“…It was noted that the degree of correlation diminished after a 20 minutes delay postdraw, suggesting that such a finding would be less useful outside of an immediate POC setting. Early in vitro studies found Sonoclotʼs PF poorly reproducible and highly influenced by PLT counts and modest correlation of the PF to PLT counts was noted in studies 62–66 . Similarly, studies are needed to fully validate whether Quantraʼs PCS measures PLT function and is not simply a reflection of PLT count.…”

Establishment of Normal Range for Thromboelastography in Healthy Middle-Aged and Elderly People of Weihai in China

“…Terada et al compared the methods of assessing the risk of bleeding after cardiac surgery and the effect of platelet transfusion; the results showed that TEG was better. TEG was originally mainly used to monitor coagulation changes in liver transplantation [ 3 ]. After decades of development, TEG has been widely used in various fields of cardiac surgery [ 4 ], postpartum hemorrhage, hemophilia, and brain trauma surgery [ 5 , 6 ].…”