Optimization of thromboelastography-guided platelet transfusion in cardiovascular surgery

Aoki, Kenji; Sugimoto, Ai; Nagasawa, Ayako; Saito, Masayuki; Ohzeki, Hajime

doi:10.1007/s11748-012-0070-y

Cited by 19 publications

(21 citation statements)

References 11 publications

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“…Ak et al () showed that using the TEG parameters, R time and MA, to guide management led to a significant reduction in platelet and FFP use ( n = 110) when compared to clinician‐directed transfusion without TEG ( n = 114). These results were replicated in a second study (Aoki et al , ). Systematic reviews of 9 (Fahrendorff et al , ) and 15 (Serraino & Murphy, ) studies where patients have been randomised to VHA‐directed management or empirical management, have given differing results with respect to volume of platelet transfusions.…”

Section: Use Of Rotem/teg/sonoclot For Guiding Transfusion and Haemosmentioning

confidence: 57%

The use of viscoelastic haemostatic assays in the management of major bleeding

et al. 2018

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Section: Use Of Rotem/teg/sonoclot For Guiding Transfusion and Haemosmentioning

confidence: 57%

The use of viscoelastic haemostatic assays in the management of major bleeding

et al. 2018

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“…Finally, TEG‐based transfusion protocols may decrease blood product requirements. This has been shown after complex cardiac cases and trauma [Shore‐Lesserson et al., ; Aoki et al., ; Tapia et al., ]. Furthermore, Tapia et al.…”

Section: Teg®/platelet Mappingmentioning

confidence: 87%

“…Finally, TEGbased transfusion protocols may decrease blood product requirements. This has been shown after complex cardiac cases and trauma [Shore-Lesserson et al, 1999;Aoki et al, 2012;Tapia et al, 2013]. Furthermore, Tapia et al report that a TEG-based transfusion algorithm may improve trauma mortality compared to 1:1:1 massive transfusion protocol [Tapia et al, 2013].…”

Section: Standard Teg ® Technology Was Developed Bymentioning

confidence: 94%

Point of Care Testing in Cardiac Surgery: Diagnostic Modalities to Assess Coagulation and Platelet Function

Stafford

Weitzel

2013

Drug Development Research

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Point of Care testing in the perioperative arena is a high priority topic, specifically in cardiac surgery where a majority of perioperative blood transfusions occur. Platelet function in particular is of interest in cardiac surgery as cardiopulmonary bypass itself creates known platelet dysfunction, but also because more and more patients are on antiplatelet agents due to coronary stenting procedures. This review will focus on presenting current data relating to platelet function in the perioperative setting, along with a brief review of general coagulation concepts. Drug Dev Res 74 : 418-427, 2013.

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“…In contrast, Coakley et al concluded that thromboelastometry was not predictive for postoperative bleeding in cardiac surgical patients undergoing CPB [47]. Consumption of allogenic blood products tends to decrease in case viscoelastic tests are used [56][57][58]. However, viscoelastic clot-based assays are mainly dependent on fibrinogen levels [47,59,60].…”

Section: Definitionmentioning

confidence: 99%

Monitoring of Haemostasis and Anticoagulation in Cardiopulmonary Bypass Patients

Bosch

Weerwind²,

Mochtar³

et al. 2014

J Hematol Thrombo Dis

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Patients undergoing cardiac surgery with cardiopulmonary bypass are at risk of increased blood loss and transfusion requirements. Contact of blood with the surgical wound and the artificial surfaces of the extra-corporeal circuit results in a coagulopathy. Haemodilution during cardiopulmonary bypass also aggravates the reduction of haemostatic factors even further. On the other hand, systemic anticoagulation using high dose unfractionated heparin challenges the adequate anticoagulant monitoring. The most frequently used test to monitor systemic anticoagulation is the whole blood activated clotting time. This has, however, proven not be a reliable test. Other haemostatic assays have their own advantages and disadvantages, but tools to monitor anticoagulation and haemostasis adequately during and after cardiopulmonary bypass are to date lacking and/or show only a weak association with clinical bleeding. Viscoelastic whole blood techniques (TEG/ROTEM) have emerged as alternatives to the routine coagulation tests, and could be more suitable for providing information about the different phases of the blood clotting. Platelet function tests give more information about the presence of platelet dysfunction one, which is a major cause of bleeding after cardiac surgery. Likewise, thrombin generation tests reflect much, if not all, of the overall function of the blood clotting system. Further research of the applicability and added values of the viscoelastic whole blood tests and the thrombin generation tests in the cardiac surgical patient undergoing cardiopulmonary bypass is warranted. Simplicity in performing the test, preferably point-of-care, and rapid availability of the results, should thereby be the primary focus for targeted haemostatic interventions. JHTD, an open access journal Volume 2 • Issue 6 • 1000179 31. Lemmer JH Jr, Despotis GJ (2002) Antithrombin III concentrate to treat heparin resistance in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg 123: 213-217. 32. Nicholson SC, Keeling DM, Sinclair ME, Evans RD (2001) Heparin pretreatment does not alter heparin requirements during cardiopulmonary bypass. Br J Anaesth 87: 844-847.

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Optimization of thromboelastography-guided platelet transfusion in cardiovascular surgery

Abstract: Use of a TEG-guided transfusion protocol dramatically reduced PT after CPB, particularly in patients undergoing aortic arch aneurysm repair.

Cited by 19 publications

References 11 publications

The use of viscoelastic haemostatic assays in the management of major bleeding

The use of viscoelastic haemostatic assays in the management of major bleeding

Point of Care Testing in Cardiac Surgery: Diagnostic Modalities to Assess Coagulation and Platelet Function

Monitoring of Haemostasis and Anticoagulation in Cardiopulmonary Bypass Patients

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