Journal ArticleDOI
Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery.
Linda Shore-Lesserson,HE Manspeizer,Marietta DePerio,S Francis,Frances Vela-Cantos,M A Ergin +5 more
TLDR
Point-of-care coagulation monitoring using TEG resulted in fewer transfusions in the postoperative period, and this data support the use of TEG in an algorithm to guide transfusion therapy in complex cardiac surgery.Abstract:
Transfusion therapy after cardiac surgery is empirically guided, partly due to a lack of specific point-of-care hemostasis monitors. In a randomized, blinded, prospective trial, we studied cardiac surgical patients at moderate to high risk of transfusion. Patients were randomly assigned to either a thromboelastography (TEG)-guided transfusion algorithm (n 5 53) or routine transfusion therapy (n 5 52) for intervention after cardiopulmonary bypass. Coagulation tests, TEG variables, mediastinal tube drainage, and transfusions were compared at multiple time points. There were no demographic or hemostatic test result differences between groups, and all patients were given prophylactic antifibrinolytic therapy. Intraoperative transfusion rates did not differ, but there were significantly fewer postoperative and total transfusions in the TEG group. The proportion of patients receiving freshfrozen plasma (FFP) was 4 of 53 in the TEG group compared with 16 of 52 in the control group (P , 0.002). Patients receiving platelets were 7 of 53 in the TEG group compared with 15 of 52 in the control group (P , 0.05). Patients in the TEG group also received less volume of FFP (36 6 142 vs 217 6 463 mL; P , 0.04). Mediastinal tube drainage was not statistically different 6, 12, or 24 h postoperatively. Point-of-care coagulation monitoring using TEG resulted in fewer transfusions in the postoperative period. We conclude that the reduction in transfusions may have been due to improved hemostasis in these patients who had earlier and specific identification of the hemostasis abnormality and thus received more appropriate intraoperative transfusion therapy. These data support the use of TEG in an algorithm to guide transfusion therapy in complex cardiac surgery. Implications: Transfusion of allogeneic blood products is common during complex cardiac surgical procedures. In a prospective, randomized trial, we compared a transfusion algorithm using point-of-care coagulation testing with routine laboratory testing, and found the algorithm to be effective in reducing transfusion requirements. (Anesth Analg 1999;88:312‐9)read more
Citations
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Combat Damage Control Resuscitation: Today and Tomorrow
TL;DR: The future of damage control resuscitation will most likely involve the refinement and customization of blood components for the individual patient and application of the principles of damage Control resuscitation in the prehospital arena.
Proceedings ArticleDOI
Photoelectronic device for measuring of small rotary angles in thromboelastography applications
TL;DR: A photoelectronic device for measuring small rotary angles was developed in this article by using position sensitive device (PSD) as its primary element and validated the feasibility of the device.
Journal ArticleDOI
S100β after coronary artery surgery: association with lipid peroxidation and neurocognitive scores.
TL;DR: The relationships between malondialdehyde production, S100β, and neurological and cognitive scoring 3 months after CABG are reported.
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Journal ArticleDOI
Prophylactic tranexamic acid decreases bleeding after cardiac operations.
Jan C. Horrow,J. Hlavacek,Michael D. Strong,W. Collier,Isadore Brodsky,S.M. Goldman,I.P. Goel +6 more
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