Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery

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.