Assessment of a Quantra-Guided Hemostatic Algorithm in High-Bleeding-Risk Cardiac Surgery

Area of Science:

• Anesthesiology
• Cardiovascular Surgery
• Transfusion Medicine

Background:

• Cardiac surgery, especially in high-risk patients, is associated with significant transfusion requirements and bleeding complications.
• Current hemostatic management often relies on standard laboratory testing, which may not always provide timely or comprehensive guidance.

Purpose of the Study:

• To evaluate the effectiveness of a Quantra-guided hemostatic algorithm in reducing transfusion needs and major bleeding.
• To compare Quantra-guided testing with traditional laboratory-guided testing in patients undergoing high-bleeding-risk cardiac surgery.

Main Methods:

• A single-center, before-and-after study was conducted involving patients undergoing high-bleeding-risk cardiac surgery with cardiopulmonary bypass.
• The hemostatic algorithm was guided by standard laboratory testing during the control period and by the Quantra system during the intervention period.
• Propensity-score matching was used to compare outcomes between the Quantra group (66 patients) and the control group (117 patients).

Main Results:

• The Quantra group received significantly fewer red blood cell (RBC) units on day 1 post-surgery (2 vs. 4 units, p=0.016).
• Intraoperative transfusions of RBCs, fresh frozen plasma, and platelets were reduced in the Quantra group.
• The incidence of major bleeding on day 1 was lower in the Quantra group (36% vs. 56%, p=0.014), and its implementation was independently associated with reduced major bleeding.

Conclusions:

• Implementing a Quantra-based hemostatic algorithm significantly decreased transfusion requirements and major bleeding in high-bleeding-risk cardiac surgery.
• Further randomized trials are necessary to validate these findings and confirm the benefits of Quantra-guided hemostasis.