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Prediction of Postoperative Blood Loss Using Thromboelastometry in Adult Cardiac Surgery: Cohort Study and Systematic
Michael I Meesters1, David Burtman1, Peter M van de Ven2
1Department of Anaesthesiology, VU University Medical Centre, Amsterdam, The Netherlands.
Objective:
The aim was to evaluate the predictive value of thromboelastometry for postoperative blood loss in adult cardiac surgery with cardiopulmonary bypass.
Design:
Retrospective cohort study and systematic review of the literature.
Setting:
A tertiary university hospital.
Participants:
202 patients undergoing elective cardiac surgery.
Interventions:
Thromboelastometry was performed before cardiopulmonary bypass and 3 minutes after protamine administration.
Measurements And Main Results:
The cohort study showed that the preoperative and postoperative thromboelastometric positive predicting value was poor (0%-22%); however, the negative predicting value was high (89%-94%). The systematic review of the literature to evaluate the predictive value of thromboelastometry for major postoperative bleeding in cardiac surgery resulted in 1,311 articles, 11 of which were eligible (n = 1,765; PubMed and Embase, until June 2016). Two studies found a good predictive value, whereas the other 9 studies showed a poor predictability for major postoperative bleeding after cardiac surgery. The overall negative predicting value was high.
Conclusions:
Thromboelastometry does not predict which patients are at risk for major postoperative bleeding.
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