Comparison of the Quantra QPlus System With Thromboelastography in Cardiac Surgery

Published:December 08, 2020DOI:


      • The Quantra Qplus System showed a strong to very strong correlation with the current standard of care (i.e. TEG5000 and conventional coagulation testing).
      • Comparable Quantra and TEG5000 test results are not directly interchangeable.
      • Initial Quantra results were available approximately 16.8 minutes earlier relative to corresponding TEG5000 results.


      Use of viscoelastic testing, such as thromboelastography (TEG), is recommended in cardiac surgery to monitor coagulation and to guide the transfusion of blood products. The Quantra QPlus System is a novel point-of-care platform that uses ultrasonic pulses to characterize dynamic changes in viscoelastic properties of a blood sample during coagulation. Despite the ability to assess similar aspects of clot formation, limited studies addressing the interchangeability of viscoelastic testing parameters exist. The primary aim of the present study was to assess the correlation and agreement between Quantra and TEG5000 results using blood samples from cardiac surgery patients.


      Tertiary care, academic medical center.


      Prospective observational study.


      Twenty-eight patients undergoing elective cardiac surgery undergoing cardiopulmonary bypass were evaluated.

      Measurements and Main Results

      Perioperative blood samples were collected and assessed using Quantra, and results were compared with TEG and conventional coagulation testing. Method comparison analysis demonstrated that Quantra parameters (Quantra clot time, clot stiffness, and fibrinogen contribution to clot stiffness) significantly correlated with TEG R and TEG G after induction of anesthesia, during cardiopulmonary bypass, and after rewarming (rs = 0.83, rs = 0.84, and rs = 0.73, respectively). However, Quantra parameters demonstrated poor agreement compared with equivalent TEG5000 parameters.


      The Quantra QPlus System significantly correlated with TEG5000, suggesting that this test may be used in a similar clinical context. Despite the strength of correlation between Quantra and TEG parameters, measurements are not interchangeable.

      Key Words

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        • Woodman RC
        • Harker LA.
        Bleeding complications associated with cardiopulmonary bypass.
        Blood. 1990; 76: 1680-1697
        • Bevan DH.
        Cardiac bypass haemostasis: Putting blood through the mill.
        Br J Haematol. 1999; 104: 208-219
        • Wikkelsø A
        • Wetterslev J
        • Møller AM
        • et al.
        Thromboelastography (TEG) or rotational thromboelastometry (ROTEM) to monitor haemostatic treatment in bleeding patients: A systematic review with meta-analysis and trial sequential analysis.
        Anaesthesia. 2017; 72: 519-531
        • Fahrendorff M
        • Oliveri RS
        • Johansson PI.
        The use of viscoelastic haemostatic assays in goal-directing treatment with allogeneic blood products - a systematic review and meta-analysis.
        Scand J Trauma Resusc Emerg Med. 2017; 25: 1-12
        • Li C
        • Zhao Q
        • Yang K
        • et al.
        Thromboelastography or rotational thromboelastometry for bleeding management in adults undergoing cardiac surgery: A systematic review with meta-analysis and trial sequential analysis.
        J Thorac Dis. 2019; 11: 1170-1181
        • Snegovskikh D
        • Souza D
        • Walton Z
        • et al.
        Point-of-care viscoelastic testing improves the outcome of pregnancies complicated by severe postpartum hemorrhage.
        Obstet Anesth Dig. 2018; 38: 82-83
      1. American College of Surgeons. ACS TQIP massive transfusion in trauma guidelines. Available at: Accessed December 16, 2020.

        • American Society of Anesthesiologists
        Practice guidelines for perioperative blood management: An update report by the American Society of Anesthesiologist Task Force on Perioperative Blood Management.
        Anesthesiology. 2015; 122: 241-275
        • Pagano D
        • Milojevic M
        • Meesters MI
        • et al.
        2017 EACTS/EACTA guidelines on patient blood management for adult cardiac surgery.
        Eur J Cardiothoracic Surg. 2018; 53: 79-111
        • Kozek-Langenecker SA
        • Ahmed AB
        • Afshari A
        • et al.
        Management of severe perioperative bleeding: Guidelines from the European Society of Anaesthesiology: First update 2016.
        Eur J Anaesthesiol. 2017; 34: 332-395
        • Raphael J
        • Mazer CD
        • Subramani S
        • et al.
        Society of Cardiovascular Anesthesiologists clinical practice improvement advisory for management of perioperative bleeding and hemostasis in cardiac surgery patients.
        J Cardiothorac Vasc Anesth. 2019; 33: 2887-2899
        • Ferrante EA
        • Blasier KR
        • Givens TB
        • et al.
        A novel device for the evaluation of hemostatic function in critical care settings.
        Anesth Analg. 2016; 123: 1372-1379
        • Reynolds PS
        • Middleton P
        • McCarthy H
        • et al.
        A comparison of a new ultrasound-based whole blood viscoelastic test (SEER sonorheometry) versus thromboelastography in cardiac surgery.
        Anesth Analg. 2016; 123: 1400-1407
        • Naik BI
        • Durieux ME
        • Knisely A
        • et al.
        SEER sonorheometry versus rotational thromboelastometry in large volume blood loss spine surgery.
        Anesth Analg. 2016; 123: 1380-1389
        • Huffmyer JL
        • Fernandez LG
        • Haghighian C
        • et al.
        Comparison of SEER sonorheometry with rotational thromboelastometry and laboratory parameters in cardiac surgery.
        Anesth Analg. 2016; 123: 1390-1399
        • Groves DS
        • Welsby IJ
        • Naik BI
        • et al.
        Multicenter evaluation of the Quantra QPlus System in adult patients undergoing major surgical procedures.
        Anesth Analg. 2020; 130: 899-909
        • Clinical and Laboratory Standards Institute
        Measurement procedure comparison and bias estimation using patient samples; approved guideline ed 3. CLSI guideline EP09.
        Clinical and Laboratory Standards Institute, Wayne, PA2018
        • Woodman R
        • Harker L.
        Bleeding complications associated with cardiopulmonary bypass.
        Blood. 1990; 76: 1680-1697
        • Lloyd-Donald P
        • Churilov L
        • Zia F
        • et al.
        Assessment of agreement and interchangeability between the TEG5000 and TEG6S thromboelastography haemostasis analysers: A prospective validation study.
        BMC Anesthesiol. 2019; 19: 45

      Linked Article

      • Same Same but Different: Viscoelastic Hemostatic Assays in Cardiac Surgery
        Journal of Cardiothoracic and Vascular AnesthesiaVol. 35Issue 4
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          VISCOELASTIC hemostatic assays (VHA) have become increasingly popular for monitoring perioperative coagulation status and guiding timely hemostatic therapy in cardiac surgery.1,2 VHA can be performed as point-of-care tests and might track perioperative coagulation disorders more accurately than standard coagulation tests.3,4 Implementation of VHA results in transfusion algorithms that have reduced the requirements of allogeneic blood products efficaciously in several studies and meta-analyses.5-7 Accordingly, the use of VHA is recommended by recent clinical guidelines in patient blood management and perioperative coagulation therapy in cardiac surgery.
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