Thromboelastography—does it impact blood component transfusion in pediatric heart surgery?

Kane, Lauren; Woodward, Cathy; Husain, S.; Frei-Jones, Melissa

doi:10.1016/j.jss.2015.07.011

Cited by 47 publications

(35 citation statements)

References 12 publications

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“…TEG has been shown to be effective in monitoring the coagulability of patients on antiplatelet and anticoagulants and in patients with clinical coagulapathies . Furthermore, TEG has been shown to decrease blood component transfusion in pediatric cardiac surgical patients and can aid in the prediction of mortality in trauma patients . Limited data exist describing the use of TEG in sheep.…”

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confidence: 99%

Assessment of Thrombelastography and Platelet Life Span in Ovines

et al. 2018

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Ovines are a common animal model for the study of cardiovascular devices, where consideration of blood biocompatibility is an essential design criterion. In the ovine model, tools to assess blood biocompatibility are limited and continued investigation to identify and apply additional assays is merited. Toward this end, the thrombelastograph, clinically utilized to assess hemostasis, was employed to characterize normal ovine parameters. In addition, platelet labeling with biotin was evaluated for its potential applicability to quantify ovine platelet life span. Mean ovine thrombelastograph values were reaction-time: 4.9 min, K-time: 2 min, angle: 64.1°, maximum amplitude: 68.6 mm, actual clot strength: 11.9 Kd/sc, and coagulation index: 1.5. Reaction time was significantly shorter and maximum amplitude, actual clot strength, and coagulation index were all significantly higher when compared to normal human thrombelastograph values suggesting some hypercoagulability of sheep blood. Biotinylation and reinfusion of ovine platelets allowed temporal tracking of the labeled platelet cohort with flow cytometry. These data indicated a mean ovine platelet life span of 188 h with a half-life of 84 h. The collection of these parameters for normal ovines demonstrates the applicability of these techniques for subsequent studies where cardiovascular devices may be evaluated, and provides an indication of normal ovine values for comparison purposes.

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confidence: 99%

Assessment of Thrombelastography and Platelet Life Span in Ovines

et al. 2018

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“…Several studies that have examined PTT, PT, and INR have found that a 1.5‐fold increase in these measurements did not clearly correlate with an increased risk of bleeding . Viscoelastic tests, such as TEG and rotational thromboelastometry (ROTEM), are gaining popularity as they offer point‐of‐care testing and allow for a more comprehensive, functional assessment of coagulation . When compared to standard coagulation studies, TEG has been associated with decreased blood products utilization without an increased risk of bleeding in adult cirrhotic patients (INR >1.8 and/or platelets <50 000/µL) .…”

Section: Discussionmentioning

confidence: 99%

Eliminating international normalized ratio threshold for transfusion in pediatric patients with acute liver failure

Lee

Mendoza

Brubaker

et al. 2020

Clinical Transplantation

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Introduction Transfusion protocols are not well‐studied for pediatric patients with acute liver failure (ALF). This study evaluates the utility of an international normalized ratio (INR)‐based transfusion threshold for these patients. Methods Forty‐four ALF pediatric patients from 2009 to 2018 were reviewed and divided into two groups: (a) a threshold group including patients between 2009 and 2015 who were transfused for an INR above 3.0, per institutional policy (n = 30), and (b) a post‐threshold group including patients after 2015 through 2018 who were transfused based on clinical judgment (n = 14). Preoperative INRs, preoperative transfusions, intraoperative transfusions, early reoperation, renal function, graft function and deaths were compared. Results Liver failure severity was similar between threshold and post‐threshold groups. Threshold patients had a lower average INR prior to transplantation, 2.8 (range 1.8‐3.8) vs 4.4 (range 2.1‐9.0), respectively (P = .01). Twenty‐six threshold patients (87%) received preoperative FFP compared with seven post‐threshold patients (50%, P = .0088). Two threshold patients (7%) received preoperative cryoprecipitate compared with five post‐threshold patients (36%, P = .014). The incidence of pre‐transplant bleeding, operative transfusions, and 1‐year patient and graft survival did not differ significantly. Conclusion Clinical judgment vs an INR‐based threshold for transfusions did not increase perioperative complications in children with ALF.

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“…Pediatric transplantation, in particular of the liver, can result in significant blood loss. However, blood product transfusion and fluid resuscitation are not without complications, including infection, thrombosis, and acute lung injury . A tailored approach is necessary to minimize adverse events.…”

Section: Introductionmentioning

confidence: 99%

“…resuscitation are not without complications, including infection, thrombosis, and acute lung injury. 5 A tailored approach is necessary to minimize adverse events. In 2011, we began employing TEG for pediatric liver transplantation.…”

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confidence: 99%

The impact of thromboelastography on resuscitation in pediatric liver transplantation

Sujka

Gonzalez

Curiel

et al. 2018

Pediatric Transplantation

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Although TEG directs effective resuscitation in adult surgical patients, pediatric data are lacking. We performed a retrospective comparative review of the effect of TEG on blood product utilization and outcomes following pediatric liver transplantation in 38 patients between 2008 and 2014. Diagnoses, laboratory values, fluid and blood product use, and outcomes were examined. Nineteen patients underwent liver transplantation prior to the implementation of TEG, and 19 had perioperative TEG. The most common indications for transplant were BA (n = 14), HB (n = 7), and metabolic disorders (n = 7). Intraoperative blood loss, urine output, fluid and blood product use were similar between groups. However, the use of fresh frozen plasma decreased significantly in TEG patients within the first 24 hours (29 vs 0 mL/kg, P < .01), and between 24 and 48 hours (12 vs 0 mL/kg, P = .01) post-operatively. The total use of fresh frozen plasma during hospitalization was markedly reduced (111 vs 17 mL/kg, P < .01). Four patients in the TEG group had thromboembolic graft complications, including portal vein or hepatic artery thrombosis, and underwent retransplantation. The decreased use of fresh frozen plasma since implementation of TEG is an important finding for resource utilization and patient safety. However, the increased incidence of thromboembolic complications requires further investigation.

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Thromboelastography—does it impact blood component transfusion in pediatric heart surgery?

Cited by 47 publications

References 12 publications

Assessment of Thrombelastography and Platelet Life Span in Ovines

Assessment of Thrombelastography and Platelet Life Span in Ovines

Eliminating international normalized ratio threshold for transfusion in pediatric patients with acute liver failure

The impact of thromboelastography on resuscitation in pediatric liver transplantation

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