PROSPECTIVE EVALUATION AND CLINICAL UTILITY OF ON-SITE MONITORING OF COAGULATION IN PATIENTS UNDERGOING CARDIAC OPERATION

Although laboratory coagulation tests permit a rational approach to bo th diagnosis and management of coagulation disorders after cardiopulmo nary bypass, their clinical utility is limited by delays in obtaining results. This study was designed to evaluate prospectively the impact of on-site coagulation testing on blood product use, operative time, a nd intraoperative management of microvascular bleeding. Patients who u nderwent cardiac procedures involving cardiopulmonary bypass and subse quently developed microvascular bleeding were randomly assigned to rec eive either standard therapy (n = 36) or therapy defined by a treatmen t algorithm based on results from an on-site coagulation monitoring la boratory (n = 30). No differences were found between treatment groups in hematologic assay data, operative procedures, or duration of cardio pulmonary bypass. Patients treated in accordance with on-site laborato ry results (algorithm therapy) received significantly less intraoperat ive fresh frozen plasma (0.4 +/- 1.1 U versus 2.4 +/- 2.8 U; p = 0.000 6) during the treatment interval, had shorter operative times, and had less mediastinal chest tube drainage during the initial perioperative interval (158 +/- 169 ml versus 326 +/- 258 ml; p = 0.003) than did p atients in the standard therapy group. Patients who underwent algorith m therapy also received fewer platelet (1.6 +/- 5.9 versus 6.4 +/- 8.2 U; p = 0.02) and red blood cell (1.9 +/- 1.7 U versus 4.1 +/- 4.1U; p = 0.01) transfusions after the operation. Nine of 36 (25 %) standard group patients received initial therapy which differed from that which would have been guided by the on-site algorithm protocol. Our finding s indicate that rapid and accurate coagulation test results can guide specific therapy and optimize treatment of microvascular bleeding in p atients who undergo cardiac operations.