Evaluation of post-cardiopulmonary bypass coagulation disorders by differential diagnosis with a multichannel modified thromboelastogram: a pilot investigation.
We assessed a modified multichannel thromboelastogram for differentiation of the causes of coagulopathy after cardiopulmonary bypass and its suitability as a therapy guide. Thirty adult patients undergoing surgery with cardiopulmonary bypass, who revealed a coagulopathy as observed by a prolonged activated clotting time of >150 sec after the application of protamine, were enrolled. Therapy was based on the results obtained by the computerized four-channel thromboelastogram with baseline, heparinase (2 IU/mL), heparinase/abciximab (5 microg/mL), and heparinase/fresh frozen plasma (25%) channels. The mean activated clotting time before therapy was 162.2+/-7.8 sec. Based on differential diagnosis with the modified multichannel thromboelastogram, two patients received protamine (30 mg), five desmopressin (0.4 microg/kg), 19 patients three units of fresh frozen plasma, two patients platelet transfusions, and two patients both protamine (30 mg) and three units of fresh frozen plasma. After therapy, there was a significant (p < .01) decrease of the activated clotting time to a mean value of 127+/-8.3 sec. Therapy based on the synoptic modified multichannel thromboelastogram analysis provides a guide for effective therapy of coagulopathy. However, elaboration is desirable, and larger clinical trials are necessary for a final evaluation of the protocol.
Koster
A
A
Department for Anesthesia, Deutsches Herzzentrum, Berlin, Germany. koster@DHZB.de
Kukucka
M
M
Fischer
T
T
Hetzer
R
R
Kuppe
H
H
D000328:Adult; D001778:Blood Coagulation Disorders / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005858:Germany; D006490:Hemostatics / Q000627:therapeutic use; D006494:Heparin Antagonists / Q000627:therapeutic use; D019763:Heparin Lyase / Q000627:therapeutic use; D006801:Humans; D010865:Pilot Projects; D011479:Protamines / Q000627:therapeutic use; D013916:Thrombelastography / Q000295:instrumentation / Q000379:methods*
D006490:Hemostatics; D006494:Heparin Antagonists; D011479:Protamines; D019763:Heparin Lyase; D003894:Deamino Arginine Vasopressin