On-site coagulation monitoring does not affect hemostatic outcome after cardiac surgery

Background: Rapid coagulation tests are now available for monitoring of ble eding patients after cardiac surgery. As inappropriate blood use in these p atients may be due to lack of timely coagulation data, we studied the effec t of an algorithm with on-line coagulation monitoring on transfusions in th ese patients. Methods: Prospectively, patients bleeding (>1.5 ml kg(-1) 15 min(-1)) after cardiac surgery were randomly assigned to two groups: in group A (n=28), h emostatic treatment during the immediate recovery period (1 h after surgery ) was based on an algorithm with on-site hemostasis monitoring, whereas dur ing the same period group B patients (n=30) were managed solely according t o the clinician's judgement; laboratory tests other than activated dotting time after heparin neutralization were prohibited. Results: Cumulative chest tube drainage up to 16 h and total transfusion re quirements did not differ between the groups. Using a platelet transfusion trigger of 100x10(9)/l, significantly more patients received platelets duri ng the immediate recovery period in the algorithm group than in the control group (14 vs. 3 patients, P=0.001). Desmopressin acetate was administered more often in group A than in group B (8 vs. 2 patients, P=0.04). Conclusions: Algorithm-based therapy increased utilization of hemostatic in terventions during the immediate recovery period without any obvious benefi t to the hemostatic outcome. Reevaluation of the platelet transfusion trigg er seems warranted.