Interv Akut Kardiol. 2005;4(4)
PERIOPERATIVE MONITORING OF CARDIAC SURGICAL PATIENTS WITH THROMBOELASTOGRAPHY
- 1 Interní hematoonkologická klinika LF MU a FN Brno
- 2 Kardiochirurgická klinika FN a LF UP v Olomouci
- 3 Centrum biostatistiky a analýz, Masarykova univerzita, Brno
Thromboelastography (TEG) is now an extensively used method of haemostasis monitoring during cardiac surgery. According to the literature, TEG is beneficial to rational therapy and reduces the use of blood products.
Methods: We evaluated 128 patients undergoing elective cardiac surgery using cardiopulmonary bypass (CPB) in a prospective study. Patients were monitored with conventional coagulation tests (before and after CPB) and simultaneously with TEG. The 146 patients of the control group were monitored only with laboratory tests and ACT. We evaluated the pathological TEG tracings obtained before, during and after surgery. During the investigation, we followed blood loss, the administration of blood products and surgical reexploration because of bleeding. We evaluated changes of haemostatic profile during CPB by means of laboratory measurement and TEG.
Results: Before the surgery, all patients had conventional coagulation tests within normal range (including platelet count). Both groups were demographically comparable. No differences between the two groups were recorded in blood loss, transfusion therapy and surgical reexploration. There was a significant trend to hypocoagulation measured with laboratory tests after surgery. By contrast, the most frequent abnormality on TEG both before and after surgery was hypercoagulation status. Only the Quick test correlated with CPB duration.
Conclusions: Most of the patients in our group showed signs of hypercoagulation on TEG tracings before elective cardiac surgery. On CPB, mostly dysfunction of platelets and fibrinolysis were recorded. These disorders are reliably and readily visible on TEG tracings and usually do not require any intervention. Despite TEG monitoring, the administration of blood products was mostly empiric.
Keywords: Key word: thromboelastography, cardiopulmonary bypass, haemostasis.
Published: January 1, 2006 Show citation