L. Shore-lesserson et al., Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery, ANESTH ANAL, 88(2), 1999, pp. 312-319
Citations number
24
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Transfusion therapy after cardiac surgery is empirically guided, partly due
to a lack of specific point-of-care hemostasis monitors. In a randomized,
blinded, prospective trial, we studied cardiac surgical patients at moderat
e to high risk of transfusion. Patients were randomly assigned to either a
thromboelastography (TEG)-guided transfusion algorithm (n = 53) or routine
transfusion therapy (n = 52) for intervention after cardiopulmonary bypass.
Coagulation tests, TEG variables, mediastinal tube drainage, and transfusi
ons were compared at multiple time points. There were no demographic or hem
ostatic test result differences between groups, and all patients were given
prophylactic antifibrinolytic therapy. Intraoperative transfusion rates di
d not differ, but there were significantly fewer postoperative and total tr
ansfusions in the TEG group. The proportion of patients receiving fresh-fro
zen plasma (FFP) was 4 of 53 in the TEG group compared with 16 of 52 in the
control group (P < 0.002). Patients receiving platelets were 7 of 53 in th
e TEG group compared with 15 of 52 in the control group (P < 0.05). Patient
s in the TEG group also received less volume of FFP (36 +/- 142 vs 217 +/-
463 mL; P < 0.04). Mediastinal tube drainage was not statistically differen
t 6, 12, or 24 h postoperatively. Point-of-care coagulation monitoring usin
g TEG resulted in fewer transfusions in the postoperative period. We conclu
de that the reduction in transfusions may have been due to improved hemosta
sis in these patients who had earlier and specific identification of the he
mostasis abnormality and thus received more appropriate intraoperative tran
sfusion therapy. These data support the use of TEG in an algorithm to guide
transfusion therapy in complex cardiac surgery. Implications: Transfusion
of allogeneic blood products is common during complex cardiac surgical proc
edures. In a prospective, randomized trial, we compared a transfusion algor
ithm using point-of-care coagulation testing with routine laboratory testin
g, and found the algorithm to be effective in reducing transfusion requirem
ents.