Thromboelastometrically guided transfusion protocol during aortic surgery with circulatory arrest: A prospective, randomized trial

Abstract

Objective: Aortic surgical procedures requiring hypothermic circulatory arrest are associated with altered hemostasis and increased bleeding. In a randomized clinical trial, we evaluated effects of thromboelastometrically guided algorithm on transfusion requirements. Methods: Fifty-six consecutive patients (25 with acute type A dissection) undergoing aortic surgery with hypothermic circulatory arrest were enrolled in a randomized trial during a 6-month period. Patients were randomly allocated to treatment group (n ¼ 27) with thromboelastometrically guided transfusion algorithm or control group (n ¼ 29) with routine transfusion practices (clinical judgment-guided transfusion followed by transfusion according to coagulation test results). Primary end point was cumulative allogeneic blood units (red blood cells, fresh-frozen plasma, and platelets) transfused. Results: Transfusion of allogeneic blood was significantly reduced in the thromboelastometry group: median 9.0 units (interquartile range, 2.0-30.0 units) versus. 16.0 units (9.0-23.0 units, P ¼ .02). Most significant decrease was in the use of fresh-frozen plasma (3.0 units, 0-12.0 units, vs 8.0 units, 4.0-18.0 units, P ¼ .005). Postoperative blood loss (890 mL/d, 600-1250 mL/d vs 950 mL/d, 650-1400 mL/d, p ¼ 0.5) and rate of surgical re-exploration (19% vs 24%, P ¼ .7) were similar between groups. Thromboelastometrically guided algorithm significantly decreased need for massive perioperative transfusion (odds ratio, 0.45; 95% confidence interval, 0.2-0.9; P ¼ .03) in multivariable logistic regression analysis. Conclusions: Thromboelastometrically guided transfusion is associated with a decreased use of allogeneic blood units and reduced incidence of massive transfusion in patients undergoing aortic surgery with circulatory arrest.

Assessment of coagulation profile by thromboelastometry in adult patients with cyanotic congenital heart disease

“…It has been shown that A5-A15 values (clot firmness 5-15 min after CT) are able to predict MCF within 5-15 min [32]. When the value of FIBTEM-A10 is b8 mm (EXTEM A10 b 45 mm and FIBTEM A10 b 15 mm) or FIBTEM-MCF is b 10 mm, these might be an indication for fibrinogen replacement [17,33,34]. If the effect of heparin is excluded, the prolonged CT values of EXTEM or INTEM (usually EXTEM-CT N 80-100 s or INTEM-CT N 240 s) can suggest that fresh frozen plasma or prothrombin complex concentration transfusion is needed [31].…”

Intrarater and interrater variability of point of care coagulation testing using the ROTEM delta

“…Perioperative monitoring of coagulation using rotational thromboelastometry represents a modern approach in perioperative point-of-care testing (POCT) in anesthesia and intensive care [1][2][3]. Thrombelastography (TEG) not only allows for studying clot formation, it also provides information about clot strength and clot lysis.…”

“…Rotational thromboelastometry (ROTEM delta; TEM Innovations GmbH, Munich, Germany), based on the classic TEG first introduced by Hartert [4], allows for fast point-of-care blood clot analysis. The ROTEM device was shown to be beneficial in detecting thrombocytopenia, low fibrinogen levels and in guiding substitution therapy with blood products and coagulation factors [3,5,6].…”

Thromboelastography‑derived parameters for the prediction of acute thromboembolism following non‑steroidal anti‑inflammatory drug‑induced gastrointestinal bleeding: A retrospective study

“…A number of patients with normal PLT, PT and APTT exhibit active bleeding and abnormal coagulation (36,37). Blood coagulation and an increase in PLT adhesion serve roles in the occurrence and development of acute thrombosis (27).…”

“…Although D-dimer levels and pAgt can provide reference data for clinical thrombosis, the information provided by TEG detection is more comprehensive and can reflect the coagulation function state more accurately. Furthermore, TEG is a simpler, faster and more sensitive detection method and can be implemented by the bedside (37). …”