Thromboelastography as an indicator of post-cardiopulmonary bypass coagulopathies

Abstract

Postoperative hemorrhage in patients undergoing open-heart surgery is a major cause of morbidity and mortality. Monitoring of coagulation in these patients has routinely involved the activated clotting time. Thromboelastography is currently used as a monitor of coagulation during liver transplantation. The thromboelastogram, by providing information on the interaction of all the coagulation precursors, gives more clinically useful information on coagulation than that available from the coagulation profile or the activated clotting time alone. This study was done to assess the usefulness of thromboelastography in open-heart surgery. Thirty-eight patients (29 undergoing coronary artery bypass grafting and 9 undergoing valve replacement) were studied with activated clotting time, thromboelastography, and coagulation profiles during three periods: before bypass, during bypass, and after protamine administration. Thromboelastography was a significantly better predictor (87% accuracy) of postoperative hemorrhage and need for reoperation than was the activated clotting time (30%) or coagulation profile (51%). Thromboelastography is easy to use and provides diagnostic data within 30 minutes of blood sampling.

Bleeding risk assessment using whole blood impedance aggregometry and rotational thromboelastometry in patients following cardiac surgery

“…Reliable methods to predict patients with higher risk of coagulation impairments are lacking [14]. Conventional coagulation tests are not able to predict postoperative bleeding [15,16]. "Blind" transfusion therapy with multiple blood products still occurs when bleeding is excessive, and transfusion of allogeneic blood products expose patients to multiple risks and increased expenses [4,[17][18][19][20].…”

Bleeding risk assessment using multiple electrode aggregometry in patients following coronary artery bypass surgery

“…Platelet function monitoring may play an important role in reducing bleeding events in patients receiving APT who require CABG by identifying patients with pronounced platelet inhibition who are prone to excessive bleeding after CABG. Previous publications have reported on the inadequacy of conventional coagulation tests in predicting postoperative bleeding [7,8]. Classic light transmission aggregometry (LTA) performed in platelet rich plasma is the "gold standard" for platelet function testing, but this method is time consuming and is not always available.…”

Thromboelastogram monitoring in the perioperative period of hepatectomy for adult living liver donation

“…It is able to provide information about platelet activation, fibrin formation, and clot retraction. It has been used extensively to guide therapy of coagulation disorders in liver transplantation, 14 cardiac surgery, 15 and preeclamptic parturients, 16 and it is also one of the most sensitive methods for detecting and monitoring postoperative hypercoagulability. 5,6,8,11,13,[17][18][19] The effects of liver resection on the coagulation cascade in living donors have not been thoroughly evaluated.…”