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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Journal ArticleDOI
Thromboelastography: where is it and where is it heading?
TL;DR: TEG is the only single test method that provides information on the balance between two important and opposing components of coagulation, namely thrombosis and lysis, and measures this interactive dynamic coagulated process from the initial clotting cascade to platelet interaction and clot strengthening.
Journal ArticleDOI
Transfusion of Allogeneic Blood Products in Proximal Aortic Surgery With Hypothermic Circulatory Arrest: Effect of Thromboelastometry-Guided Transfusion Management
Jens Fassl,Peter Matt,Friedrich Eckstein,Miodrag Filipovic,Michael Gregor,Urs Zenklusen,Manfred D. Seeberger,Daniel Bolliger +7 more
TL;DR: Allogeneic blood products were avoided in a proportion of patients and thromboelastometry-guided coagulation management promoting the use of coagulations factor concentrates decreased the useof allogeneicBlood products during complex cardiac surgery.
Journal ArticleDOI
Promoting High-Value Practice by Reducing Unnecessary Transfusions With a Patient Blood Management Program.
Divyajot Sadana,Ariella Pratzer,Lauren J. Scher,Harry S. Saag,Nicole Adler,Frank M. Volpicelli,Moises Auron,Steven M. Frank +7 more
TL;DR: A blueprint is presented for developing a patient blood management program, which includes discussion of specific methods for optimizing transfusion practice, and the most recent transfusions practice guidelines and the evidence supporting these guidelines.
Journal ArticleDOI
Thromboelastography and rotational thromboelastometry in bleeding patients with coagulopathy: Practice management guideline from the Eastern Association for the Surgery of Trauma.
Nikolay Bugaev,John J. Como,Guy Golani,Jennifer J. Freeman,Jaswin S Sawhney,Cory Vatsaas,Brian K. Yorkgitis,Laura A Kreiner,Nicole M. Garcia,Hiba Abdel Aziz,Peter A. Pappas,Eric J. Mahoney,Zachary W Brown,George Kasotakis +13 more
TL;DR: In patients with ongoing hemorrhage and concern for coagulopathy, this practice management guideline conditionally recommend using TEG/ROTEM-guided transfusions, compared with traditional coagulation parameters, to guide blood component transfusions in each of the following three groups: adult trauma patients, adult surgical patients, and adult patients with critical illness.
Journal ArticleDOI
The coagulopathy of cardiopulmonary bypass
Martin Besser,Andrew A. Klein +1 more
TL;DR: An overview of intra- and postoperative monitoring of coagulation with special emphasis on the near-patient testing, its main complications, and the transfusion support is provided, while taking into account the major changes in the technology used and supportive care provided since its inception.
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Changes in transfusion therapy and reexploration rate after institution of a blood management program in cardiac surgical patients
TL;DR: Use of TEG monitoring before reexploration has decreased the cost and potential risk for patients undergoing CABG surgery and the incidence of reoperation for hemorrhage.
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
TL;DR: It is concluded that prophylactic tranexamic acid can be administered safely to inhibit fibrinolysis during cardiac operations, decrease postoperative bleeding, and possibly decrease the frequency of blood product transfusion.