Activated coagulation time vs. intrinsically activated modified rotational thromboelastometry in assessment of hemostatic disturbances and blood loss after protamine administration in elective cardiac surgery: analysis from the clinical trial (NCT01281397)

Journal of Cardiothoracic Surgery

Hrvoje Gasparovic⁴  Milan Milosevic³  Sanja Konosic²  Ante Lekić⁴  Marko Boban⁵  Lucija Svetina⁴  Davor Milicic¹  Bojan Biocina⁴  Mate Petricevic⁴ 

[1] University of Zagreb School of Medicine, Department of Cardiovascular Diseases, University Hospital Center Zagreb, Zagreb, Croatia;University of Zagreb School of Medicine, Department of Anesthesiology, University Hospital Center Zagreb, Zagreb, Croatia;University of Zagreb School of Medicine, Andrija Stampar School of Public Health, Zagreb, Croatia;Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia;Department of Cardiology, University Hospital “Thalassotherapia Opatija”, Medical School University of Rijeka and Osijek, Opatija, Croatia

关键词: Bleeding management;    Transfusion;    Activating coagulation time;    Cardiac surgery;    Hemorrhage;    Rotational thromboelastometry;   

Others  :  1151952
DOI  :  10.1186/1749-8090-9-129

 received in 2013-09-30, accepted in 2014-03-11,  发布年份 2014

【 摘 要 】

Background

Excessive bleeding after cardiopulmonary bypass (CPB) is risk factor for adverse outcomes after elective cardiac surgery (ECS). Although many different point-of-care devices to diagnose hemostatic disturbances after CPB are available, the best test is still unclear. The study aim was to compare the accuracy of hemostatic disorder detection between two point-of-care devices.

Methods

We enrolled 148 patients (105 male and 43 female) undergoing ECS in a prospective observational study. Rotational thromboelastometry (TEM, with InTEM test), and Activated coagulation time (ACT) measurement were performed 15 min after protamine administration. The cohort group was divided into two subgroups according to occurrence of excessive postoperative bleeding. Endpoints were defined in two ways: as total amount of chest tube output (CTO) and blood product transfusion requirements.

Results

Total amount of CTO value of 1507,50 mL presented 75th percentile of distribution, thus cut-off value for bleeder category. InTEM parameters, but not ACT, correlated significantly with CTO. InTEM parameters with the strongest correlation to CTO were tested for accuracy in predicting excessive postoperative bleeding using ROC analysis. InTEM A 10 value of 38 mm, InTEM A 20 value of 49 mm and InTEM A 30 value of 51 mm delineated bleeding tendency. Patients with total amount of CTO exceeding 75th percentile were more frequently transfused with fresh frozen plasma (51.4% vs. 9.9%, p < 0.001), fibrinogen concentrate (21.6% vs. 2.7%, p = 0.001) and platelet concentrate (13.5% vs. 0.9%, p = 0.004).

Conclusion

Our study showed that InTEM test, but not ACT is useful in prediction of bleeding tendency after protamine administration following weaning from CPB. InTEM test could be used as a first line test in screening of possible hemostatic disorder following protamine administration.

【 授权许可】

   
2014 Petricevic et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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