Point-of-care viscoelastic hemostatic testing in cardiac surgery patients: a systematic review and meta-analysis

Lodewyks, Carly; Heinrichs, Jeffrey; Grocott, Hilary P.; Karkouti, Keyvan; Romund, Grace; Arora, Rakesh C.; Tangri, Navdeep; Rabbani, Rasheda; Abou-Setta, Ahmed M; Zarychanski, Ryan

doi:10.1007/s12630-018-1217-9

Cited by 30 publications

(98 citation statements)

References 28 publications

(98 reference statements)

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“…All of this brings us back to the conclusion by Lodewyks et al 5 While I agree that VHT is not ready for ''routine implementation'', I would emphasize the word routine. Anyone hoping to reduce blood product transfusion by purchasing a TEG or ROTEM device and blindly following an algorithm is likely to be very disappointed.…”

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confidence: 87%

“…implementation''. 5 This statement is likely to raise many readers' eyebrows and deserves further discussion to place it in the proper context.…”

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confidence: 99%

“…Arguably, it is at least as pertinent as any of the other proposed primary outcomes listed in Table 1. In fact, I would submit that expecting a point-ofcare test to influence mortality (a primary end point in Lodewyks et al) 5 is a pretty tall order! In any case, it is fascinating to note that despite assessing disparate, albeit overlapping, literature (five studies in common) for the secondary outcome of platelet exposure, all meta-analyses arrived at very similar effect estimates-using VHT lowers the risk of receiving a platelet transfusion by approximately 30%.…”

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confidence: 99%

“…présentent une revue systématique de la littérature et une méta-analyse des TVH chez les patients subissant une chirurgie cardiaque. 5 À partir de 11 essais contrôlés randomisés différents ayant inclus plus de 8000 patients, les auteurs ont trouvé qu'il n'y avait pas de réduction du pourcentage de patients exposés à des produits sanguins allogéniques. Ils concluent donc que « les bénéfices associés aux tests de visco-élasticité chez les patients de chirurgie cardiaque ne sont pas suffisamment solides pour recommander leur implémentation dans la pratique courante ».…”

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“…Ils concluent donc que « les bénéfices associés aux tests de visco-élasticité chez les patients de chirurgie cardiaque ne sont pas suffisamment solides pour recommander leur implémentation dans la pratique courante ». 5 Une telle affirmation fera sans doute froncer les sourcils de nombreux lecteurs et mérite une plus large discussion pour la replacer dans son contexte.…”

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Viscoelastic testing: It’s not the measurement, it’s what you do with it!

Sniecinski

2018

Can J Anesth/J Can Anesth

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Anesthesiologists love to measure things. Heart rate, blood pressure, and pulse oximetry values all provide information that aids in directing anesthetic care. In fact, these measurements are necessary to provide a safe anesthetic. Laboratory measurements also play a role in guiding therapy, albeit without the instant gratification of vital sign changes. For example, most practitioners would feel uncomfortable administering insulin to a patient without the ability to measure a blood glucose level at some point. Transfusion of blood products is a more complex issue, but one that also relies heavily on measurement-or at least it should. The use of viscoelastic hemostatic testing (VHT) in surgical patients has exploded over the past decade, in part because of its ability to simultaneously measure several components of coagulation. No less than a half dozen different perioperative Societies have published guidelines recommending its use for directing the transfusion of hemostatic blood products. 1-4 Yet, questions still remain about the efficacy of this testing modality, including how we act upon the information it provides. In this issue of the Journal, Lodewyks et al. present a systematic review and meta-analysis of VHT in cardiac surgical patients. 5 Using 11 different randomized-controlled trials involving over 8,000 patients, the authors found no reduction in the proportion of patients exposed to allogenic blood products. They conclude that ''the benefits associated with viscoelastic testing in cardiac surgery patients are insufficiently robust to recommend routine 123

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Point-of-care viscoelastic hemostatic testing in cardiac surgery patients: a systematic review and meta-analysis

Abstract: PROSPERO (CRD4201706577). Registered 11 May 2017.

Cited by 30 publications

References 28 publications

Viscoelastic testing: It’s not the measurement, it’s what you do with it!

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