On-site coagulation monitoring does not affect hemostatic outcome after cardiac surgery.
BACKGROUND
Rapid coagulation tests are now available for monitoring of bleeding patients after cardiac surgery. As inappropriate blood use in these patients may be due to lack of timely coagulation data, we studied the effect of an algorithm with on-line coagulation monitoring on transfusions in these patients.


METHODS
Prospectively, patients bleeding (>1.5 ml kg(-1) 15 min(-1)) after cardiac surgery were randomly assigned to two groups: in group A (n=28), hemostatic treatment during the immediate recovery period (1 h after surgery) was based on an algorithm with on-site hemostasis monitoring, whereas during the same period group B patients (n=30) were managed solely according to the clinician's judgement; laboratory tests other than activated clotting time after heparin neutralization were prohibited.


RESULTS
Cumulative chest tube drainage up to 16 h and total transfusion requirements did not differ between the groups. Using a platelet transfusion trigger of 100x10(9)/l, significantly more patients received platelets during the immediate recovery period in the algorithm group than in the control group (14 vs. 3 patients, P=0.001). Desmopressin acetate was administered more often in group A than in group B (8 vs. 2 patients, P=0.04).


CONCLUSIONS
Algorithm-based therapy increased utilization of hemostatic interventions during the immediate recovery period without any obvious benefit to the hemostatic outcome. Re-evaluation of the platelet transfusion trigger seems warranted.
Capraro
L
L
Finnish Red Cross Blood Transfusion Service, Helsinki. leena.capraro@bts.redcross.fi
Kuitunen
A
A
Salmenperä
M
M
Kekomäki
R
R
D000368:Aged; D000465:Algorithms; D000758:Anesthesia; D000925:Anticoagulants / Q000627:therapeutic use; D001777:Blood Coagulation / Q000502:physiology*; D016063:Blood Loss, Surgical; D006348:Cardiac Surgical Procedures; D005260:Female; D006489:Hemostatic Techniques; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D016896:Treatment Outcome; D014914:Whole Blood Coagulation Time
D000925:Anticoagulants; D006493:Heparin