Effect of thrombelastography on timing of coronary artery bypass grafting

Abstract

The guiding value of thrombelastography (TEG) on the selection of surgical timing for patients scheduled for coronary artery bypass grafting (CABG) was investigated. A total of 90 subjects with acute coronary syndrome (ACS) treated between February 2014 and December 2016 in Henan Provincial People's Hospital were recruited. The patients received dual antiplatelet therapy (DAPT) and were scheduled for CABG. Subjects were randomly allocated into two groups, TEG group (n=45) and non-TEG group (n=45). Patients in the TEG group withheld medications at 24 h prior to surgery and received TEG examination. Based on maximum amplitude of adenosine diphosphate (MAADP), subjects were further grouped into three sub-groups with MAADP <35 mm, 35–50 mm, and >50 mm, and accordingly received CABG within 1 day, 3–5 days and 5 days later, respectively. Subjects in the control group (non-TEG group) received CABG 5–7 days after medication withdrawal. Chest drainage volume within 24 h after surgery and red blood cell transfusion during perioperative period were compared. Other recorded parameters were incubation period, intensive care unit length of stay, hospital stay, incidence of 30-day adverse events and readmission rate. The average waiting time before CABG for patients of TEG group was shorter compared with the commonly recommended time. The red blood cell transfusions during perioperative period of subjects in TEG group and non-TEG group were significantly different (P=0.23). The median hospital stay of subjects in TEG group was shorter than that of non-TEG group (P=0.037). The bleeding amount of patients in TEG group was 220.16±80.56 ml, which was significantly lower than that of non-TEG group (435.29±90.16). The difference was statistically significant (P=0.032). The results suggested that TEG assay-based evaluation of platelet function for patients scheduled for CABG reasonably guides surgeons with appropriate surgical timing and reduces the amount of time patients wait to be treated.

Using Thromboelastography to Predict Blood Loss After Off-Pump Coronary Artery Bypass Grafting

“…Hemorrhage after cardiac surgery is correlated with many factors, including patient characteristics, preoperative medication, operation conditions, and anesthesia management. Previous studies 15–17 have shown that TEG can be used to preoperatively evaluate the platelet function in patients undergoing OPCABG, help surgeons choose the most suitable operation time, and reduce the waiting time before surgery. As mentioned in the 2017 European Association for Cardio-Thoracic Surgery’s Guidelines on Patient Blood Management for Adult Cardiac Surgery, 14 platelet function testing can be used to guide and determine the timing of cardiac surgery in patients who have recently received P2Y 12 inhibitors or are receiving DAPT.…”

“…Hemorrhage after cardiac surgery is correlated with many factors, including patient characteristics, preoperative medication, operation conditions, and anesthesia management. Previous studies [15][16][17] have shown Note: CABG related myocardial infarction: patients with cardiac troponin elevation more than 10 times the upper 99th percentile of the reference value after CABG. Abbreviations: TEG, thromboelastography; NSTEMI, non-ST segment elevation myocardial infarction; PCI, percutaneous transluminal coronary intervention; APTT, activated partial thromboplastin time; PT, prothrombin time.…”

Modified Thromboelastography for Peri-interventional Assessment of Platelet Function in Cardiology Patients: A Narrative Review

“…74 However, the use of a TEG PlateletMapping Assay-based management strategy to stratify patient waiting times based on platelet reactivity was shown to reduce the waiting time after stopping antiplatelet medications (most commonly clopidogrel) to an average of 2.7 days, without increasing the bleeding risk or the use of blood products during surgery. 75,76 A similar study of patients in China, using the TEG PlateletMapping Assay to stratify presurgical timing for patients on DAPT, also showed a reduced waiting time to 3.2 days prior to coronary artery bypass grafting, with no statistically significant difference in blood transfusions during surgery. 66…”

Application of Activators Ecarin and Factor Xa in Thrombelastography for Measurement of Anticoagulant Effect of Direct Oral Anticoagulants Using TEG 5000

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Thrombelastography is a useful tool in global hemostasis assessment and in reducing infusion of blood products in patients at risk of severe bleeding conditions such as trauma and open-heart surgery. 1,2 As the use of direct oral anticoagulants (DOACs) has become more prevalent, the clinicians are observing more cases of bleeding in patients who are chronically anticoagulated with these agents for indications such as atrial fibrillation and thromboembolic diseases. There are chromogenic assays available to assess the DOAC concentrations.

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