Abstract
BackgroundBleeding complications in cardiac surgery may lead to increased morbidity and mortality. Traditional blood coagulation tests are not always suitable to detect rapid changes in the patient's coagulation status. Point-of-care instruments such as the TEG (thromboelastograph) and RoTEM (thromboelastometer) have been shown to be useful as a guide for the clinician in the choice of blood products and they may lead to a reduction in the need for blood transfusion, contributing to better patient blood management.MethodsThe purpose of this study was to evaluate the ability of the TEG, RoTEM and Sonoclot instruments to detect changes in hemostasis in elective cardiac surgery with cardiopulmonary bypass and to investigate possible correlations between variables from these three instruments and routine hematological coagulation tests. Blood samples from thirty-five adult patients were drawn before and after surgery and analyzed in TEG, RoTEM, Sonoclot and routine coagulation tests. Data were compared using repeated measures analysis of variance and Pearson's test for linear correlation.ResultsWe found significant changes for all TEG variables after surgery, for three of the RoTEM variables, and for one variable from the Sonoclot. There were significant correlations postoperatively between plasma fibrinogen levels and variables from the three instruments.ConclusionsTEG and RoTEM may be used to detect changes in hemostasis following cardiac surgery with CPB. Sonoclot seems to be less suitable to detect such changes. Variables from the three instruments correlated with plasma fibrinogen and could be used to monitor treatment with fibrinogen concentrate.
Highlights
Bleeding complications in cardiac surgery may lead to increased morbidity and mortality
Perioperative monitoring of the hemostatic process by a combination of conventional coagulation tests may be helpful in diagnosing possible causes of bleeding [15,16]
The primary objective of this study was to evaluate the comparability of the results obtained from the TEG, RoTEM and Sonoclot instruments by assessing their ability to detect changes in hemostasis caused by Cardiopulmonary bypass (CPB)
Summary
Bleeding complications in cardiac surgery may lead to increased morbidity and mortality. Excessive bleeding in cardiac surgery occurs in as much as 20% of patients It is associated with increased morbidity and mortality, mainly caused by need for reexploration and transfusion of blood products [1,2,3,4,5,6]. In 15-50% of the patients undergoing reexploration, a surgical cause of bleeding cannot be found [7,8] and it is assumed to be of microvascular origin. The pathogenesis of microvascular bleeding in cardiac surgery is multifactorial and may be related to changes in the hemostatic system associated. Perioperative monitoring of the hemostatic process by a combination of conventional coagulation tests may be helpful in diagnosing possible causes of bleeding [15,16]. The value of these tests has been questioned, mainly because they are time-consuming, performed in plasma and do not add information about platelet function or the contribution of the cellular components [17,18]
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