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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Effect of thrombelastography on timing of coronary artery bypass grafting
Zhiyuan Yang1, Zhouliang Xie1, Xueliang Pei1
1Department of Cardiovascular Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, P.R. China.
Insights
Thrombelastography (TEG) guides surgical timing for coronary artery bypass grafting (CABG) patients on dual antiplatelet therapy (DAPT). This approach reduces waiting times and bleeding, improving patient outcomes.
Area of Science:
- Cardiology
- Hematology
- Surgical Innovation
Background:
- Patients with acute coronary syndrome (ACS) undergoing coronary artery bypass grafting (CABG) often receive dual antiplatelet therapy (DAPT).
- Determining optimal surgical timing after DAPT cessation is critical to balance bleeding risk and ischemic events.
- Current practices for surgical timing may lead to prolonged waiting periods.
Purpose of the Study:
- To investigate the guiding value of thrombelastography (TEG) in selecting surgical timing for patients scheduled for CABG.
- To compare outcomes between patients managed with TEG-guided timing and standard timing protocols.
Main Methods:
- A randomized controlled trial involving 90 ACS patients scheduled for CABG receiving DAPT.
- Patients were allocated to a TEG group (n=45) or a non-TEG (control) group (n=45).
- TEG analysis guided surgical timing in the TEG group based on adenosine diphosphate (ADP) induced platelet function (MAADP), while the control group followed standard 5-7 day withdrawal.
Main Results:
- The TEG group experienced a significantly shorter median hospital stay (P=0.037).
- The TEG group had significantly lower bleeding amounts (220.16±80.56 ml vs 435.29±90.16 ml, P=0.032).
- While not statistically significant (P=0.23), red blood cell transfusions differed between groups.
Conclusions:
- Thrombelastography (TEG) provides a valuable tool for guiding surgical timing in CABG patients on DAPT.
- TEG-guided timing can potentially reduce perioperative bleeding and hospital stay.
- This approach allows for more appropriate and potentially expedited surgical intervention.
Abstract:
The guiding value of thrombelastography (TEG) on the selection of surgical timing for patients scheduled for coronary artery bypass grafting (CABG) was investigated. A total of 90 subjects with acute coronary syndrome (ACS) treated between February 2014 and December 2016 in Henan Provincial People's Hospital were recruited. The patients received dual antiplatelet therapy (DAPT) and were scheduled for CABG. Subjects were randomly allocated into two groups, TEG group (n=45) and non-TEG group (n=45). Patients in the TEG group withheld medications at 24 h prior to surgery and received TEG examination. Based on maximum amplitude of adenosine diphosphate (MAADP), subjects were further grouped into three sub-groups with MAADP <35 mm, 35-50 mm, and >50 mm, and accordingly received CABG within 1 day, 3-5 days and 5 days later, respectively. Subjects in the control group (non-TEG group) received CABG 5-7 days after medication withdrawal. Chest drainage volume within 24 h after surgery and red blood cell transfusion during perioperative period were compared. Other recorded parameters were incubation period, intensive care unit length of stay, hospital stay, incidence of 30-day adverse events and readmission rate. The average waiting time before CABG for patients of TEG group was shorter compared with the commonly recommended time. The red blood cell transfusions during perioperative period of subjects in TEG group and non-TEG group were significantly different (P=0.23). The median hospital stay of subjects in TEG group was shorter than that of non-TEG group (P=0.037). The bleeding amount of patients in TEG group was 220.16±80.56 ml, which was significantly lower than that of non-TEG group (435.29±90.16). The difference was statistically significant (P=0.032). The results suggested that TEG assay-based evaluation of platelet function for patients scheduled for CABG reasonably guides surgeons with appropriate surgical timing and reduces the amount of time patients wait to be treated.
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