Thromboelastogram-Guided Transfusion Therapy Reduces Blood-Component Transfusion and Improves Coagulation Function during Orthopedic Surgery

Abstract

Massive bleeding is a serious medical complication arising from trauma, surgery, and invasive procedures. In this case, timely and effective hemostasis must be applied to patients. The aim of this study is to compare transfusion therapies guided by thromboelastogram (TEG) and conventional coagulation tests (CCTs) during orthopedic surgery, focusing on blood-component transfusion and coagulation function of patients. The patients who underwent orthopedic surgery in our hospital from May 2019 to November 2020 were retrospectively analyzed. According to different transfusion-guiding strategies, the patients were assigned into the CCT group containing 214 patients and the TEG group containing 266 patients. The TEG group used fewer volumes of blood products including red blood cell (RBC) suspension, fresh-frozen plasma, cryoprecipitate, and apheresis platelets than the CCT group ( P < 0.05 ). After orthopedic surgery, the hemoglobin (Hb) and RBC counts were decreased, but the white blood cell (WBC) counts were increased in all patients receiving whether transfusion therapy guided by TEG or CCTs. Importantly, the TEG group exhibited fewer WBC counts concomitant with higher Hb and more RBC counts than the CCT group ( P < 0.05 ). There was no significant difference on the platelet (PLT) counts between the two groups before and after orthopedic surgery ( P > 0.05 ). Significant declines on thrombin time (TT), partial activated thromboplastin time (PATT), prothrombin time (PT), and d-dimer (D-D), along with an increase on fibrinogen (FIB) were observed in two groups after surgery. The TEG group showed reduced TT, PATT, PT, D-D, and elevated FIB compared to the CCT group ( P < 0.05 ). Posttransfusion, the K value (time to reach a certain clot strength) and R value (coagulation reaction time) were decreased, the angle (α) value (clot formation rate), MA value (maximum amplitude), and CI (coagulation index) were increased in the TEG group ( P < 0.05 ). When the liver function was assessed, it was found that the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total serum bilirubin (TBIL) were increased significantly, and albumin (ALB) was decreased between the two groups after surgery, but the TEG group with lower levels of ALT, AST, and TBIL and a higher level of ALB than the CCT group ( P < 0.05 ). With regard to the renal function, two groups had increased levels of serum creatinine (Scr) and blood urea nitrogen (BUN) with a declined uric acid (UA) level after surgery; however, the patients in the TEG group had lower levels of Scr and BUN and a higher level of UA compared to the CCT group ( P < 0.05 ). In view of above data, TEG-guided transfusion therapy could reduce use of blood products, optimize blood components, and improve coagulation function for patients undergoing orthopedic surgery. TEG-guided transfusion therapy may prevent liver and renal dysfunction after orthopedic surgery.

Recommendations from the ICM-VTE: General

“…Another retrospective review of perioperative transfusions during orthopaedic spine procedures, fracture, and total joint arthroplasty (TJA) surgery found TEG-guided transfusion therapy reduced and optimized blood components (p < 0.05) with improved coagulation function (p < 0.05) and decreased hospital length of stay (p < 0.001) as compared to CCT. The risk of bleeding and thrombosis was not specifically studied 659 .…”

Viscoelastic Hemostatic Assays for Orthopedic Trauma and Elective Procedures

“…In addition, the TEG-guided BCT patients were found to have shorter hospital stays compared to the CCT-guided group. This suggests that the TEG guidance of intraoperative BCT during elective orthopedic surgery is associated with optimized blood product usage and potentially improved outcomes overall [ 80 ]. The ability of CCTs versus ROTEM to identify perioperative coagulopathy in patients who underwent major elective orthopedic surgery was evaluated in 40 patients undergoing elective THA, femur fracture fixation, and spinal surgery.…”