Related Experiment Video
Updated: Oct 28, 2025
In Vitro Thrombosis Test for Ventricular Assist Devices
Published on: March 21, 2025
Role of Using a Thromboelastometry-Based Protocol for Transfusion Management in Combined Coronary Artery Bypass
Elham Khalaf-Adeli1, Ali Akbar Pourfathollah1,2, Fereidoon Noohi3
1Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.
Insights
This study shows that using a thromboelastometry (ROTEM)-based protocol significantly reduced blood product transfusions, including fresh frozen plasma and platelets, in patients undergoing combined heart surgery.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Transfusion Medicine
Background:
- Combined coronary artery bypass grafting (CABG) and valve surgery are complex procedures often associated with significant blood loss and high transfusion rates.
- Optimizing transfusion strategies is crucial for improving patient outcomes and managing blood product resources.
Purpose of the Study:
- To evaluate the impact of a thromboelastometry (ROTEM)-based transfusion protocol on transfusion requirements in patients undergoing elective combined CABG and valve surgery.
- To compare transfusion needs between patients managed with a ROTEM-guided protocol versus standard care.
Main Methods:
- A randomized clinical trial involving 80 adult patients undergoing elective combined CABG and valve surgery.
- Patients were allocated to either a ROTEM-guided transfusion group (n=40) or a control group (n=40) receiving standard care.
- Transfusion decisions in the ROTEM group were based on a specific thromboelastometry protocol, while the control group followed conventional coagulation testing and clinical judgment.
Main Results:
- The ROTEM-guided protocol led to a 67% reduction in overall blood product units consumed and a 23% decrease in the percentage of patients transfused.
- Significant reductions were observed in the consumption of fresh frozen plasma (FFP) and platelets.
- No significant differences were found in red blood cell (RBC) transfusion rates or the number of RBC units transfused between the groups.
Conclusions:
- Implementing a thromboelastometry-based transfusion protocol can substantially reduce blood product usage in patients undergoing combined CABG and valve surgery.
- This approach is particularly effective in decreasing the need for fresh frozen plasma and platelet transfusions.
- Thromboelastometry offers a valuable tool for optimizing transfusion management in high-risk cardiac surgical patients.
Abstract:
The aim of this study was to evaluate the impact of using a thromboelastometry-based protocol on transfusion requirements in patients undergoing combined coronary artery bypass grafting (CABG) and valve surgery. 80 adult patients scheduled for elective combined CABG and valve surgery were included in this clinical trial study. Patients were randomly allocated to the thromboelastometry (ROTEM) (n = 40) or control groups (n = 40). In the ROTEM group, transfusion was directed according to a thromboelastometry-based protocol. In the control group, transfusion was conducted according to the routine practices including conventional coagulation testing and clinical judgments. Finally, transfusion requirements were compared between groups. Use of thromboelastometry- based protocol resulted in 67% reduction in blood products units' consumption as well as 23% in the percentage of patients transfused. This reduction was especially evident in relation to fresh frozen plasma (FFP) and platelet consumption. No significant differences were found both in the percentage of patients receiving RBC and number of transfused RBC units. Using thromboelastometry tests incorporated a protocol results in reduction of transfusion requirements in patients undergoing elective combined CABG and valve surgery.
