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Related Experiment Video

Updated: Jan 4, 2026

Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
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Thrombelastometry guided blood-component therapy after cardiac surgery: a randomized study.

Martin Haensig1, Joerg Kempfert2, Pia-Maria Kempfert2

  • 1Department of Vascular Surgery, Cardiovascular Center, University of Leipzig, Liebigstr 20, 04103, Leipzig, Germany. mhaensig@gmail.com.

BMC Anesthesiology
|November 8, 2019
PubMed
Summary

Rotational thromboelastometry (ROTEM®) guided therapy for cardiac surgery bleeding is effective. In patients with long cardiopulmonary bypass times, ROTEM® significantly reduced bleeding and 5-year mortality.

Keywords:
BleedingBlood-component therapyCardiac surgeryPoint-of-care testingThrombelastometryTransfusion

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Area of Science:

  • Cardiovascular Surgery
  • Hematology
  • Point-of-Care Testing

Background:

  • Postoperative bleeding is a significant complication after cardiac surgery, associated with adverse outcomes.
  • Thrombelastometry (ROTEM®) offers point-of-care coagulation assessment, but its clinical utility in this setting requires further evaluation.
  • Limited data exists on the efficacy of ROTEM®-guided blood component therapy in managing significant postoperative bleeding.

Purpose of the Study:

  • To evaluate the effectiveness of ROTEM®-guided blood component therapy compared to standard algorithm-based treatment in patients experiencing significant postoperative bleeding after cardiac surgery.
  • To assess transfusion requirements, re-thoracotomy rates, and postoperative drainage loss.
  • To investigate the impact of ROTEM®-guided therapy on long-term mortality, particularly in high-risk subgroups.

Main Methods:

  • A randomized trial involving 104 patients with significant postoperative bleeding (>200 ml/h) following cardiac surgery.
  • Patients were randomized to either a 4-chamber ROTEM®-guided transfusion protocol or a control group receiving standard coagulation testing-based treatment.
  • Key parameters included mean age, EuroSCORE, cardiopulmonary bypass (CPB) time, and cross-clamp time.

Main Results:

  • No significant differences in overall transfusion requirements or re-thoracotomy rates were observed between the ROTEM® and control groups.
  • A trend towards reduced 24-hour drainage loss was noted in the ROTEM® group (p=0.066).
  • In patients with long CPB times (>115 min), ROTEM®-guided treatment significantly decreased 24-hour drainage loss (p=0.032) and reduced 5-year mortality (0% vs. 15%, p=0.03).

Conclusions:

  • ROTEM®-guided treatment for postoperative bleeding after cardiac surgery is at least as effective as standard therapy.
  • In patients with prolonged CPB times, ROTEM®-guided therapy may lead to reduced bleeding, cost savings, and improved long-term survival.
  • Point-of-care rotational thromboelastometry offers a valuable tool for optimizing blood management in complex cardiac surgical patients.