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Goal-directed hemostatic therapy using the rotational thromboelastometry in patients requiring emergent cardiovascular surgery


1 Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospital, CH-1211, Geneva, Switzerland
2 Department of Cardiovascular Surgery, University Hospital, CH-1211, Geneva, Switzerland
3 Department of Anesthesia and Intensive Care, Cardiocentro Ticino, CH-6900 Lugano, Switzerland
4 Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospital, CH 1211; Faculty of Medicine, University of Geneva, Geneva, Switzerland

Correspondence Address:
Marc Licker
Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil, CH-1205, Geneva, Switzerland. Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital Geneva, CH-1211, Geneva, Switzerland

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.129829

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Year : 2014  |  Volume : 17  |  Issue : 2  |  Page : 100-108

 

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Aims and Objectives: We assessed the clinical impact of goal-directed coagulation management based on rotational thromboelastometry (ROTEM) in patients undergoing emergent cardiovascular surgical procedures. Materials and Methods: Over a 2-year period, data from 71 patients were collected prospectively and blood samples were obtained for coagulation testing. Administration of packed red blood cells (PRBC) and hemostatic products were guided by an algorithm using ROTEM-derived information and hemoglobin level. Based on the amount of PRBC transfused, two groups were considered: High bleeders (≥5 PRBC; HB) and low bleeders (<5 PRBC; LB). Data were analyzed using Chi-square test, unpaired t-test and analysis of variance as appropriate. Results: Pre-operatively, the HB group (n = 31) was characterized by lower blood fibrinogen and decreased clot amplitude at ROTEM compared with the LB group (n = 40). Intraoperatively, larger amounts of fibrinogen, fresh frozen plasma and platelets were required to normalize the coagulation parameters in the HB group. Post-operatively, the incidence of major thromboembolic and ischemic events did not differ between the two groups (<10%) and the observed in-hospital mortality was significantly less than expected by the Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM score, 22% vs. 35% in HB and 5% vs. 13% in LB group). Conclusions: ROTEM-derived information is helpful to detect early coagulation abnormalities and to monitor the response to hemostatic therapy. Early goal-directed management of coagulopathy may improve outcome after cardiovascular surgery.






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1 Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospital, CH-1211, Geneva, Switzerland
2 Department of Cardiovascular Surgery, University Hospital, CH-1211, Geneva, Switzerland
3 Department of Anesthesia and Intensive Care, Cardiocentro Ticino, CH-6900 Lugano, Switzerland
4 Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospital, CH 1211; Faculty of Medicine, University of Geneva, Geneva, Switzerland

Correspondence Address:
Marc Licker
Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil, CH-1205, Geneva, Switzerland. Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital Geneva, CH-1211, Geneva, Switzerland

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.129829

Rights and Permissions

Aims and Objectives: We assessed the clinical impact of goal-directed coagulation management based on rotational thromboelastometry (ROTEM) in patients undergoing emergent cardiovascular surgical procedures. Materials and Methods: Over a 2-year period, data from 71 patients were collected prospectively and blood samples were obtained for coagulation testing. Administration of packed red blood cells (PRBC) and hemostatic products were guided by an algorithm using ROTEM-derived information and hemoglobin level. Based on the amount of PRBC transfused, two groups were considered: High bleeders (≥5 PRBC; HB) and low bleeders (<5 PRBC; LB). Data were analyzed using Chi-square test, unpaired t-test and analysis of variance as appropriate. Results: Pre-operatively, the HB group (n = 31) was characterized by lower blood fibrinogen and decreased clot amplitude at ROTEM compared with the LB group (n = 40). Intraoperatively, larger amounts of fibrinogen, fresh frozen plasma and platelets were required to normalize the coagulation parameters in the HB group. Post-operatively, the incidence of major thromboembolic and ischemic events did not differ between the two groups (<10%) and the observed in-hospital mortality was significantly less than expected by the Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM score, 22% vs. 35% in HB and 5% vs. 13% in LB group). Conclusions: ROTEM-derived information is helpful to detect early coagulation abnormalities and to monitor the response to hemostatic therapy. Early goal-directed management of coagulopathy may improve outcome after cardiovascular surgery.






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