The kaolin-activated Thrombelastograph® predicts bleeding after cardiac surgery

Objective: The objective of this study was to determine the relationship of the kaolin-activated Thrombelastograph(R) (TEG) with postoperative bleeding and laboratory tests of coagulation in the setting of cardiac surgery with the routine use of epsilon-aminocaproic acid. Design: Prospective observational study. Setting: An adult heart center at a tertiary referral, university hospital. Participants: Thirty adult cardiac surgical patients. Interventions: The kaolin-activated TEG, platelet counts, prothrombin times, activated partial thromboplastin times, and fibrinogen levels were measured before induction of anesthesia, during cardiopulmonary bypass, and on arrival in the intensive care unit. Mediastinal and thoracostomy drainage were measured every hour for 4 hours after arrival in the intensive care unit. Measurements and Main Results: Correlation and multivariate linear regression modeling were used to describe relationships among coagulation tests, TEG parameters, and early postoperative bleeding. The TEG maximum amplitude (MA) parameter correlated well with postoperative bleeding (r = -0.6, p = 0.0018), more so than platelet count (r = -0.45, p = 0.02), fibrinogen level (r = -0.40, p = 0.06), or prothrombin time (r = 0.43, p = 0.02). The receiver operating characteristic curve c-index describing MA as a predictor for postoperative bleeding is 0.78. Abnormalities in all the laboratory test results were associated with an abnormal MA. Conclusions: In conclusion, the kaolin-activated TEG is associated with early coagulopathic bleeding. It may reflect the severity of a global coagulopathy affecting both platelets and coagulation factors and be a guide to incremental prohemostatic therapy in this setting. (C) 2006 Elsevier Inc. All rights reserved.