Immediate Post-Bypass Thromboelastography and Concordance With Transfusion Practice in Cardiac Surgery: A Retrospective Observational Study
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Published on: November 24, 2014
Nattaya Raykateeraroj1, Nuanprae Kitisin2, Yukiko Hikasa3
1Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Anaesthesia, Austin Health, Heidelberg, Australia.
Objectives:
To evaluate the concordance between immediate post-cardiopulmonary bypass thromboelastography (TEG) findings and intraoperative transfusion practice in adult cardiac surgery.
Design:
Single-center retrospective observational study.
Setting:
Tertiary academic hospital.
Participants:
Adults undergoing cardiac surgery with cardiopulmonary bypass who had immediate post-bypass TEG performed in the operating theater.
Interventions:
None.
Measurements And Main Results:
Manufacturer-derived TEG thresholds for fresh frozen plasma, platelets, cryoprecipitate, and procoagulant therapy were compared with observed intraoperative transfusion practice. Among 207 patients, thresholds were met in 56% for fresh frozen plasma, 20% for platelets, 17% for cryoprecipitate, and 16% for procoagulants. Intraoperative transfusion rates were higher for platelets, cryoprecipitate, and procoagulants, particularly in complex surgery, whereas fresh frozen plasma transfusion was lower than the threshold-based proportion. Among patients meeting thresholds but not receiving transfusions intraoperatively, fewer than 15% required the corresponding product within 24 hours. Postoperative chest tube output was broadly similar across TEG-transfusion patterns, with no clear association between TEG concordance and early postoperative bleeding.
Conclusions:
Substantial discordance existed between manufacturer-derived post-bypass TEG thresholds and intraoperative transfusion practice. Transfusion appeared to reflect surgical complexity more closely than measured coagulation abnormalities.