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

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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
Previous ArticleIntraoperative measurement of activated partial thromboplastin time and prothrombin time by a portable laser photometer in patients following 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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      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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