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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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.
Makar M, Taylor J, Zhao M, Farrohi A, Trimming M, D’Attellis N (2010) Perioperative coagulopathy, bleeding, and hemostasis during cardiac surgery: a comprehensive review. ICU Dir 1:17–27
Görlinger K, Shore-Lesserson L, Dirkmann D, Hanke AA, Rahe- Meyer N, Tanaka KA (2013) Management of hemorrhage in cardiothoracic surgery. J Cardiothorac Vasc Anesth 27:S20–S34
Ferraris VA, Saha SP, Oestreich JH, Song HK, Rosengart T, Reece TB et al (2012) Update to the society of thoracic surgeons guideline on use of antiplatelet drugs in patients having cardiac and noncardiac operations. Ann Thorac Surg 94:1761–1781
Carroll RC, Chavez JJ, Snider CC, Meyer DS, Muenchen RA (2006) Correlation of perioperative platelet function and coagulation tests with bleeding after cardiopulmonary bypass surgery. J Lab Clin Med 147:197–204
Crowther MA, Warkentin TE (2008) Bleeding risk and the management of bleeding complications in patients undergoing anticoagulant therapy: focus on new anticoagulant agents. Blood 111:4871–4879
Karlsson M, Ternstrom L, Hyllner M, Baghaei F, Flinck A, Skrtic S et al (2009) Prophylactic fibrinogen infusion reduces bleeding after coronary artery bypass surgery. A prospective randomised pilot study. Thromb Haemost 102:137–144
Sniecinski RM, Chen EP, Makadia SS, Kikura M, Bolliger D, Tanaka KA (2010) Changing from aprotinin to tranexamic acid results in increased use of blood products and recombinant factor VIIa for aortic surgery requiring hypothermic arrest. J Cardiothorac Vasc Anesth 24:959–963
Fassl J, Matt P, Eckstein F, Filipovic M, Gregor M, Zenklusen U et al (2013) Transfusion of allogeneic blood products in proximal aortic surgery with hyopthermic circulatory arrest: effects of thromboelastometry-guided transfusion management. J Cardiothorac Vasc Anesth 27(6):1181–1188
Kawashima S, Suzuki Y, Sato T, Kikura M, Katoh T, Sato S (2016) Four-group classification based on fibrinogen level and fibrin polymerization associated with postoperative bleeding in cardiac surgery. Clin Appl Thromb Hemost 22:648–655
Nuttall GA, Oliver WC, Ereth MH, Santrach PJ (1997) Coagulation tests predict bleeding after cardiopulmonary bypass. J Cardiothorac Vasc Anesth 11(7):815–823
Segal JB, Dzik WH, Transfusion Medicine/Hemostasis Clinical Trials Network (2005) Paucity of studies to support that abnormal coagulation test results predict bleeding in the setting of invasive procedures: an evidence-based review. Transfusion 45(9):1413–1425
Vasques F, Spiezia L, Manfrini A et al (2017) Thromboelastometry guided fibrinogen replacement therapy in cardiac surgery: a retrospective observational study. J Anesth 31(2):286–290
Hanna JM, Keenan JE, Wang H, Andersen ND, Gaca JG, Lombard FW, Welsby IJ, Hughes GC (2016) Use of human fibrinogen concentrate during proximal aortic reconstruction with deep hypothermic circulatory arrest. J Thorac Cardiovasc Surg 151:376–382
Ternström L, Radulovic V, Karlsson M, Baghaei F, Hyllner M, Bylock A, Hansson KM, Jeppsson A (2010) Plasma activity of individual coagulation factors, hemodilution and blood loss after cardiac surgery: a prospective observational study. Thromb Res 126:e128–e133
Ranucci M, Baryshnikova E (2016) Fibrinogen supplementation after cardiac surgery: insights from the zero-plasma trial (ZEPLAST). Br J Anaesth 116:618–623
Perez-Ferrer A, Vicente-Sanchez J, Carceles-Baron MD, Van der Linden P, Faraoni D (2015) Early thromboelastometry variables predict maximum clot firmness in children undergoing cardiac and noncardiac surgery. Br J Anaesth 115:896–902
Rahe-Meyer N, Hanke A, Schmidt DS, Hagl C, Pichlmaier M (2013) Fibrinogen concentrate reduces intraoperative bleeding when used as first-line hemostatic therapy during major aortic replacement surgery: results from a randomized, placebo-controlled trial. J Thorac Cardiovasc Surg 145:S178–S185
Rahe-Meyer N, Solomon C, Hanke A, Schmidt DS, Knoerzer D, Hochleitner G, Sørensen B, Hagl C, Pichlmaier M (2013) Effects of fibrinogen concentrate as first-line therapy during major aortic replacement surgery: a randomized, placebo-controlled trial. Anesthesiology 118:40–50
Ichikawa J, Marubuchi T, Nishiyama K, Kodaka M, Görlinger K, Ozaki M et al (2018) Introduction of thromboelastometry guidance for the administration of fresh frozen plasma is associated with decreased allogeneic blood transfusions and postoperative blood loss in cardiopulmonary bypass surgery. Blood Transfus 16(3):244–252
Fleming K, Redfern RE, March RL et al (2017) TEG-directed transfusion in complex cardiac surgery: impact on blood product usage. J Extra Corpor Technol 49:283–290
We are thankful to all the staffs of department of transfusion medicine for their support during audit and data collection.
We did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors for this study.
Conflict of interest
The authors declare that they have no conflict of interest.
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.
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
- Cardiac surgery