Thromboelastometry Based Early Goal-Directed Coagulation Management Reduces Blood Transfusion Requirements, Adverse Events, and Costs in Acute Type A Aortic Dissection: A Pilot Study

Abstract

Background: In aortic surgery bleeding complications can be fatal. Therefore, rotational thromboelastometry(ROTEM^TM)based coagulation management was introduced. Methods: After 5 cases of acute type A aortic dissection and aortic arch replacement had been treated based on ROTEM findings (ROTEM group; RG), 5 cases without ROTEM were matched as control group (CG). CG treatment was based on conventional tests and clinical findings. Blood component and coagulation factor requirements, ventilation time, duration of stay at intensive care unit (ICU), hospitalization, and thrombotic or bleeding incidents as well as transfusion-associated costs were compared. Results: Administration of blood products and coagulation factor concentrates, ventilation time, ICU length of stay, and hospitalization tended to be lower in RG. Postoperative plasma transfusion (p = 0.038), recognized incidents (p = 0.048), and resulting costs on coagulation treatment (p = 0.049) were significantly reduced. Conclusion: Our data suggest that ROTEM-based coagulation management can reduce transfusion requirements and corresponding costs in patients with aortic arch replacement. These data has to be confirmed by prospective randomized trials.

Long-term safety and efficacy of a pasteurized nanofiltrated prothrombin complex concentrate (Beriplex P/N): a pharmacovigilance study

“…29 34 An additional three thromboembolic events (cerebral infarction, pulmonary embolism, and an embolism of a brachial artery) which were potentially associated with PCC administration were described in a retrospective pilot study of patients undergoing aortic arch replacement after acute type A aortic dissection. 49 All patients in this study underwent prolonged cardiopulmonary bypass including isolated head perfusion and a phase with deep hypothermic Table 3) A 70-yr-old male patient with metastatic gastrointestinal cancer and arrhythmia absoluta was treated with marketed Beriplex P/N 1500 IU during a clinical study. The patient had already received the study drug (also Beriplex P/N) when he was in need of a second infusion of PCC, and was thus treated with a marketed batch of Beriplex P/N (not study drug)…”

Results of “elephant trunk” total aortic arch replacement using a multi-branched, collared graft prosthesis

“…Furthermore, patients with acute aortic dissection and surgery with hypothermic cardiac arrest experience impairment of blood coagulation [20,21]. We face this challenge by a differentiated analysis of the coagulation using ROTEM and specific administration of cellular and noncellular blood products [22], but in many cases even this differentiated therapy does not have the desired success. In cases of severe diffuse bleeding, we prefer performing definitive sternal closure within 48 h after the primary surgery when bleeding has stopped [8].…”

Point of care coagulation testing in neurosurgery

“…Reduction of transfusion requirements have been reported for cardiac surgery [6], aortic arch replacement [27] and liver transplantation [28]. A recent meta-analysis of nine trials regarding the use of viscoelastic tests in 776 patients at risk of massive transfusion demonstrated a significant reduction in blood loss through the use of TEG and ROTEM [29].…”