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Coagulopathy and hemostatic monitoring in cardiac surgery: an update

Pär I Johansson1, Sacha Sølbeck, Gustav Genet

  • 1Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University of Copenhagen, Denmark. per.johansson@rh.regionh.dk

Scandinavian Cardiovascular Journal : SCJ
|March 2, 2012
PubMed

Insights

Viscoelastic hemostatic assays (VHA) outperform routine coagulation tests in predicting bleeding and reducing transfusions after cardiac surgery. Real-time monitoring with VHA ensures timely hemostatic therapy for patients undergoing cardiopulmonary bypass.

Area of Science:

  • Cardiovascular Surgery
  • Hematology
  • Anesthesiology

Background:

  • Cardiac surgery using cardiopulmonary bypass (CPB) frequently causes hemostatic system derangements.
  • These derangements increase risks of microvascular bleeding, excessive transfusion, and surgical re-exploration, potentially leading to adverse outcomes and increased mortality.

Purpose of the Study:

  • To review coagulopathies in cardiac surgery and their monitoring.
  • To compare the efficacy of viscoelastic hemostatic assays (VHA) versus routine coagulation tests (RCoT) in managing bleeding and transfusion needs.

Main Methods:

  • A review of coagulopathies in cardiac surgery.
  • Analysis of 16 studies (over 3250 patients, including 3 RCTs) comparing VHA to RCoT.
  • Evaluation of VHA's ability to predict bleeding, re-do surgery, and influence transfusion requirements.

Main Results:

  • All 16 studies showed VHA superiority over RCoT in predicting bleeding and the need for re-do surgery.
  • VHA-guided therapy significantly reduced total blood product transfusions compared to RCoT-based therapy or clinician discretion.

Conclusions:

  • Effective management of cardiac surgery coagulopathies requires timely hemostatic therapy.
  • Real-time monitoring with VHA, including TEG/ROTEM and whole blood platelet aggregometry, is crucial for optimal patient care.
Abstract

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