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Original article| Volume 7, ISSUE 4, P410-415, August 1993

Comparison of thromboelastography to bleeding time and standard coagulation tests in patients after cardiopulmonary bypass

  • James H. Essell
    Correspondence
    Address reprint requests to MA.I James H Essell, Department of Hematology-Medical Oncology Service, Wilford Hall USAF Medical Center/PSMH 2200 Beigquist Dr, Suite 1, Lackland AFB, TX 78236-5300.
    Affiliations
    From the Departments of Hematology-Medical Oncology Service, Anesthesiology, and Cardiothoracic Surgery, Wilford Hall USAF Medical Center, Lackland AFB, TX. USA
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  • Thomas J. Martin
    Affiliations
    From the Departments of Hematology-Medical Oncology Service, Anesthesiology, and Cardiothoracic Surgery, Wilford Hall USAF Medical Center, Lackland AFB, TX. USA
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  • John Salinas
    Affiliations
    From the Departments of Hematology-Medical Oncology Service, Anesthesiology, and Cardiothoracic Surgery, Wilford Hall USAF Medical Center, Lackland AFB, TX. USA
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  • James M. Thompson
    Affiliations
    From the Departments of Hematology-Medical Oncology Service, Anesthesiology, and Cardiothoracic Surgery, Wilford Hall USAF Medical Center, Lackland AFB, TX. USA
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  • Vernon C. Smith
    Affiliations
    From the Departments of Hematology-Medical Oncology Service, Anesthesiology, and Cardiothoracic Surgery, Wilford Hall USAF Medical Center, Lackland AFB, TX. USA
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DOI:https://doi.org/10.1016/1053-0770(93)90161-D
Comparison of thromboelastography to bleeding time and standard coagulation tests in patients after cardiopulmonary bypass
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      Abstract

      This prospective study of 36 adult patients undergoing cardiopulmonary bypass (CPB) was conducted to determine the utility of thromboelastography (TEG) versus platelet studies (bleeding time, platelet count, mean platelet volume) and standard coagulation tests (prothrombin time, activated partial thromboplastin time, fibrinogen) to more effectively discriminate patients likely to benefit from platelet or fresh frozen plasma (FFP) transfusion. Although the sensitivities of the bleeding time (71.4%) and platelet count (100%) were similar to the TEG (71.4%), the specificity (89.3%) of the TEG was greater than that of the bleeding time (78.5%) and platelet count (53.6%). Seven patients experienced clinically significant hemorrhage; 5 (71.4%) had an abnormal TEG. Three of 8 (38%) other patients with an abnormal TEG had no abnormal bleeding. Only 2 of 27 (7.4%) patients with a normal TEG had abnormal bleeding requiring platelet or FFP transfusion. Therefore, it is suggested that post-CPB patients with a normal TEG should not receive platelet or FFP transfusions empirically. If excessive bleeding is noted in a patient with a normal TEG, this suggests a surgically correctable etiology. Data from this series suggest that patients displaying an abnormal TEG appear to be at increased risk for hemorrhage; therefore, appropriate blood product support should be initiated at the first sign of accelerated bleeding.

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      References

        • Merrill E.W.
        Properties of materials affecting the behavior of blood at their surfaces: behavior of blood and its components at interfaces.
        Ann N Y Acad Sci. 1977; 6: 283-284
        • Colman R.W.
        Surface-mediated defense reactions: The plasma contact activation system.
        J Clin Invest. 1984; 73: 1249-1253
        • Harker L.A.
        • Malpass T.W.
        • Branson H.E.
        • et al.
        Mechanisms of abnormal bleeding in patients undergoing cardiopulmonary bypass: Acquired transient platelet dysfunction associated with selected alpha granule release.
        Blood. 1980; 56: 824-834
        • Mammen E.F.
        • Koets M.H.
        • Washington B.C.
        • et al.
        Hemostasis changes during cardiopulmonary bypass surgery.
        Semin Thromb Hemost. 1985; 11: 281-292
        • Edmunds Jr, L.H.
        • Ellison N.
        • Colman R.W.
        • et al.
        Platelet function during open heart surgery: Comparison to the membrane and bubble oxygenators.
        J Thorac Cardiovasc Surg. 1982; 83: 805-812
        • Harding S.A.
        • Shakoov M.A.
        • Grindon A.J.
        Platelet support for cardiopulmonary bypass surgery.
        J Thorac Cardiovasc Surg. 1975; 70: 350-353
        • Mohr R.
        • Golan M.
        • Martinowitz U.
        • et al.
        Effect of cardiac operation on platelets.
        J Thorac Cardiovasc Surg. 1986; 92: 434-441
        • Simon T.L.
        • Akl B.F.
        • Murphy W.P.
        Controlled trial of routine administration of platelet concentrates in cardiopulmonary bypass surgery.
        Ann Thorac Surg. 1984; 37: 359-364
        • National Blood Resource Education Program
        Indications for the use of red blood cells, platelets, and fresh frozen plasma.
        in: Transfusion Alert. ed 2. Publication No. 9–2974a (abstr). National Institutes of Health, Bethesda, MD1989
        • Hartert H.
        Blutgerinnungstudien mil der Thrombelastographic, einern neuen Untersuchingsverfahren.
        Klin Wochenschur. 1948; 16: 257-260
        • Spiess B.D.
        • Tuman K.J.
        • McCarthy R.J.
        • et al.
        Thromboelastography as an indicator of post-cardiopulmonary bypass coagulopathies.
        J Clin Monit. 1987; 3: 25-30
        • Tuman K.J.
        • Spiess B.D.
        • McCarthy R.J.
        • et al.
        Comparison of viscoelastic measures of coagulation after cardiopulmonary bypass.
        Anesth Analg. 1989; 69: 69-75
        • Tuman K.J.
        • McCarthy R.J.
        • Patel R.V.
        • et al.
        Comparison of thromboelastography and platelet aggregometry.
        Anesthesiology. 1991; 75: A433
        • Cohen N.D.
        • Munoz A.
        • Reitz B.A.
        • et al.
        Transmission of retroviruses by transfusion of screened blood in patients undergoing cardiac surgery.
        N Engl J Med. 1989; 320: 1172-1176
        • Aymond J.P.
        • Janot C.
        • Gayet S.
        • et al.
        Posttransfusion non-A, non-B hepatitis after cardiac surgery.
        Vox Sang. 1986; 51: 236-238
        • Bull B.S.
        • Huse W.M.
        • Brouer F.S.
        • Korpman R.A.
        Heparin therapy during extracorporeal circulation: 11: The use of a dose response curve to individualize heparin and protamine dosage.
        J Thorac Cardiovasc Surg. 1975; 69: 685-689
        • Woodman R.C.
        • Harker L.A.
        Bleeding complications associated with cardiopulmonary bypass.
        Blood. 1990; 76: 1680-1697
        • Kang Y.G.
        • Martin D.J.
        • Marquez J.
        • et al.
        Intraoperative changes in blood coagulation and thromboelastographic monitoring in liver transplantation.
        Anesth Analg. 1985; 64: 888-896
        • Zuckerman L.
        • Cohen E.
        • Vagher J.P.
        • et al.
        Comparison of thromboelastography with common coagulation tests.
        Thromb Haemost. 1981; 46: 752-756
        • Spiess B.D.
        • McCarthy R.J.
        • Tuman K.J.
        • et al.
        Diffuse intravascular coagulation and primary fibrinolysis differentiated by thromboelastography.
        Anesthesiology. 1988; 69: A258

      Article info

      Footnotes

      ☆This is a US government work. There are no restrictions on its use

      ☆☆This is a US government work. There are no restrictions on its use. The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Defense or other Departments of the US Government.

      Identification

      DOI: https://doi.org/10.1016/1053-0770(93)90161-D

      Copyright

      © 1993 Published by Elsevier Inc.

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