Abstract 17313: Evaluating the Predictive Accuracy of Viscoelastic Blood Coagulation Measurements for Postoperative Bleeding in Cardiac Surgery: A Diagnostic Accuracy Meta-Analysis

Abstract

Introduction: Postoperative bleeding in cardiac surgery significantly impacts patient morbidity and mortality. Viscoelastic blood coagulation measurements, such as point-of-care (POC) viscoelastic hemostatic assays (VHAs), are proposed tools for predicting this complication and enabling proactive management. However, thoroughly evaluating existing evidence is essential to confirm their effectiveness. Hypothesis: This study aims to evaluate the diagnostic accuracy of viscoelastic blood coagulation measurements in predicting postoperative bleeding following cardiac surgery. Methods: A systematic search of studies published up to May 2022 was conducted, employing databases such as PubMed, EMBASE, and the Cochrane Library. Included studies implemented viscoelastic blood coagulation measurements in cardiac surgery settings, providing data on diagnostic accuracy for predicting postoperative bleeding. Major postoperative blood loss, as defined within each study setting, was used as the reference standard. Statistical analysis was performed using R software (version 4.0.3) with mada package. This analysis enabled various diagnostic accuracy metrics pooling, all presented with a 95% Confidence Interval (CI). Results: This analysis incorporated 10 studies comprising 2048 patients, 374 of them experienced confirmed postoperative bleeding after cardiac surgery. The pooled sensitivity and specificity of viscoelastic blood coagulation measurements for predicting postoperative bleeding were found to be 65% (95% CI: 42.9-82%, I2=89.4%) and 85% (95% CI: 69.7-93.3%, I2=95.1%) respectively. The false-positive rate was identified as 15% (95% CI: 6.7-30.3%). The diagnostic odds ratio was 10.50 (95% CI: 2.93-37.57). The positive and negative Likelihood Ratios were 4.34 (95% CI: 1.89-9.95) and 0.42 (95% CI: 0.23-0.75), respectively. Conclusions: Despite moderate sensitivity, viscoelastic blood coagulation measurements exhibit high specificity in predicting postoperative bleeding in cardiac surgery, potentially enhancing patient management through early intervention. However, due to the observed heterogeneity, further large-scale studies are required to confirm these results and assess their impact on patient outcomes.