Related Experiment Video
Updated: Dec 14, 2025
Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization
Published on: June 4, 2020
Retrospective Analysis of Thromboelastography-Directed Transfusion in Isolated CABG: Impact on Blood Product Use,
Roberta E Redfern1, Gabriel Naimy1, Michael Kuehne2
1Research Department, ProMedica Toledo Hospital, Toledo, Ohio.
Insights
Point-of-care thromboelastography (TEG) significantly reduced blood product use by over 40% in cardiac surgery patients. This led to fewer reoperations and lower costs, without impacting mortality or readmissions.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Anesthesiology
Background:
- Cardiac surgery is a major consumer of blood products, accounting for 20% of US blood use.
- Allogeneic transfusions are linked to increased morbidity and mortality risks.
- Reducing blood product administration is crucial for patient safety and healthcare costs.
Purpose of the Study:
- To evaluate the impact of implementing point-of-care thromboelastography (TEG) on blood product administration.
- To assess the effect of TEG on clinical outcomes and costs in patients undergoing coronary artery bypass grafting (CABG).
Main Methods:
- Retrospective review of isolated CABG patients before (2008-2009) and after (2011-2012) TEG implementation.
- Comparison of blood product usage, reoperation rates, mortality, and costs between the two periods.
- Statistical analysis using logistic regression and generalized linear models.
Main Results:
- Overall blood product use decreased by over 40% post-TEG implementation.
- Mediastinal re-exploration for bleeding reduced significantly (4.8% vs. 1.5%).
- Blood costs and patient charges were significantly lower after TEG introduction.
Conclusions:
- TEG effectively guided intra- and perioperative blood product administration in CABG.
- TEG use led to reduced chest tube drainage, fewer returns to the OR, and improved coagulopathic diagnosis.
- TEG implementation resulted in significant cost savings and improved clinical outcomes.
Abstract:
Cardiac surgeries account for approximately 20% of blood use in the United States. Allogeneic transfusion has been associated with increased risk of morbidity and mortality, further justifying the need to reduce blood use. This study aimed at determining whether a point-of-care coagulation test, thromboelastography (TEG), impacted blood product administration and outcomes. Patients undergoing isolated coronary artery bypass grafting (CABG) were retrospectively reviewed before the use of TEG (2008-2009) (n = 640) and after implementation (2011-2012) (n = 458). Blood product use was compared between time frames. Logistic regression and generalized linear models were created to estimate the impact on outcomes including the reoperation rate, mortality, and cost. The mean use of each blood product was significantly reduced in the perioperative period. Overall blood product use was decreased by over 40%. Mediastinal re-exploration of bleeding was significantly reduced with TEG (4.8 vs. 1.5%). Six-month mortality was not impacted in this cohort nor was the readmission rate or hospital length of stay. However, blood cost and patient charges were significantly lower after TEG was introduced. The use of TEG to guide the administration of blood products during isolated CABG significantly affected the amounts and types of products given intra- and perioperatively. This resulted in less chest tube drainage, fewer returns to the operating room, and more accurate diagnosis of coagulopathic status. Cost savings to the patient and institution were appreciated as a consequence of these improved clinical outcomes.
