The Impact of Thromboelastography on Blood Transfusion Policy in Adult Cardiac Surgery—A Retrospective Observational Study from Eastern India

Abstract

This study was conducted to determine the impact of thromboelastography (TEG) on blood transfusion policy regarding utilization and preparation of cryoprecipitate in adult cardiac surgery. The differences in total transfusion requirement, length of postoperative ICU stay and 24 h mortality were also studied after introduction of TEG in transfusion protocol. It was a retrospective, single-center, observational study conducted in adult patients underwent cardiac surgery from April 2008 to March 2016. Two thousand patients underwent surgery when TEG was used compared with 1000 control patients before availability of TEG. Significantly more patients in the TEG group versus the control group received cryoprecipitate (41 vs. 7%; p < 0.05), while fewer received a transfusion (60 vs. 87.5%; p < 0.05). Significant increase in cryoprecipitate preparation was observed after introduction of TEG. Patients underwent surgery in TEG group showed substantial reduction in administration of PRBC (2.1 vs. 3.5 U; p < 0.05); FFP (2.4 vs. 3.8 U; p < 0.05) and platelets (1.1 vs. 2.7 U; p < 0.05) compared to control group without compromising the length of ICU stay or postoperative mortality. A TEG-guided approach in adult patients undergoing cardiac surgery may increase the use of cryoprecipitate, while decreasing the overall requirement of blood transfusion.

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Fig. 1

Data transparency

All records were obtained from blood component issue register book and hospital electronic medical record system. The endpoint was transfusion details of allogeneic blood products during and within 24-hours of surgery. Blood component preparation book was audited to obtain the cryoprecipitate preparation details during this period as an inventory measurement process.

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Acknowledgements

We are thankful to all the staffs of department of transfusion medicine for their support during audit and data collection.

Funding

We did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors for this study.

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Contributions

SSD designed the study; audited; collected data and prepared the draft.DD provided support during data analysis. SSD wrote the manuscript. Both the authors reviewed the manuscript before submission.

Corresponding author

Correspondence to Suvro Sankha Datta.

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The authors declare that they have no conflict of interest.

Ethics Approval

Ethical approval was waived by the local Ethics Committee of The Mission Hospital in view of the retrospective nature of the study and all the procedures being performed were part of the blood bank audit.

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No clinical intervention was performed; only the retrospective data audit was done; individual consent was not obtained as each information was anonymized and the submission did not include any image of any person.

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Datta, S.S., De, D. The Impact of Thromboelastography on Blood Transfusion Policy in Adult Cardiac Surgery—A Retrospective Observational Study from Eastern India. Indian J Hematol Blood Transfus (2020). https://doi.org/10.1007/s12288-020-01310-y

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Keywords

  • Thromboelastography
  • Cryoprecipitate
  • Cardiac surgery
  • Inventory
  • Transfusion