Journal
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA
Volume 32, Issue 1, Pages 141-150Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.jvca.2017.08.025
Keywords
cardiac surgery; thromboelastometry; prediction; bleeding; transfusion
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Funding
- department of Cardio-thoracic Surgery of the VU University Medical Centre, Amsterdam, The Netherlands
- Medtronic, Minneapolis, MN
- Edwards Lifesciences, Irvine, CA
- St. Jude Medical, St. Paul, MN
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Objective: The aim was to evaluate the predictive value of thromboelastometry for postoperative blood loss in adult cardiac surgery with cardiopulmonary bypass. Design: Retrospective cohort study and systematic review of the literature. Setting: A tertiary university hospital. Participants: 202 patients undergoing elective cardiac surgery. Interventions: Thromboelastometry was performed before cardiopulmonary bypass and 3 minutes after protamine administration. Measurements and Main Results: The cohort study showed that the preoperative and postoperative thromboelastometric positive predicting value was poor (0%-22%); however, the negative predicting value was high (89%-94%). The systematic review of the literature to evaluate the predictive value of thromboelastometry for major postoperative bleeding in cardiac surgery resulted in 1,311 articles, 11 of which were eligible (n = 1,765; PubMed and Embase, until June 2016). Two studies found a good predictive value, whereas the other 9 studies showed a poor predictability for major postoperative bleeding after cardiac surgery. The overall negative predicting value was high. Conclusions: Thromboelastometry does not predict which patients are at risk for major postoperative bleeding. (C) 2018 The Authors. Published by Elsevier Ltd.
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