Changes in transfusion therapy guided by thromboelastograph in cardiac surgery

Area of Science:

• Cardiovascular Surgery
• Hematology
• Anesthesiology

Background:

• Postoperative bleeding is a significant complication after coronary artery bypass graft (CABG) surgery.
• Current methods for managing bleeding and coagulopathy rely on routine coagulation tests and clinical judgment, which may not be sufficiently sensitive or timely.

Purpose of the Study:

• To evaluate the efficacy of thromboelastography (TEG) in predicting excessive postoperative bleeding after CABG surgery.
• To assess TEG's role in detecting coagulopathy, guiding blood product transfusion, and informing reexploration decisions.

Main Methods:

• A prospective randomized study of 150 patients undergoing CABG surgery.
• The study group received TEG analysis (with heparinase pretreatment) to guide blood product therapy, while the control group received standard care.
• Significant bleeding was defined as >100ml/hr in the first 3 hours or >300ml in the first 3 hours and >75ml/hr in the next 3 hours.

Main Results:

• TEG demonstrated 92% accuracy in predicting excessive postoperative bleeding.
• The TEG-guided group showed significantly reduced consumption of whole blood (p=0.03), packed red blood cells (p=0.05), and fresh frozen plasma (p=0.001).
• Higher hematocrit levels were observed in the TEG group up to 36 hours post-surgery.

Conclusions:

• Thromboelastography is a valuable diagnostic tool for identifying coagulopathies following cardiopulmonary bypass.
• TEG facilitates appropriate blood and blood component therapy, minimizing unnecessary transfusions and associated risks.
• Heparinase pretreatment enhances the accuracy of TEG in detecting coagulopathy.