The kaolin-activated Thrombelastograph predicts bleeding after cardiac surgery.
OBJECTIVE
The objective of this study was to determine the relationship of the kaolin-activated Thrombelastograph (TEG) with postoperative bleeding and laboratory tests of coagulation in the setting of cardiac surgery with the routine use of -aminocaproic acid.


METHODS
Prospective observational study.


METHODS
An adult heart center at a tertiary referral, university hospital.


METHODS
Thirty adult cardiac surgical patients.


METHODS
The kaolin-activated TEG, platelet counts, prothrombin times, activated partial thromboplastin times, and fibrinogen levels were measured before induction of anesthesia, during cardiopulmonary bypass, and on arrival in the intensive care unit. Mediastinal and thoracostomy drainage were measured every hour for 4 hours after arrival in the intensive care unit.


RESULTS
Correlation and multivariate linear regression modeling were used to describe relationships among coagulation tests, TEG parameters, and early postoperative bleeding. The TEG maximum amplitude (MA) parameter correlated well with postoperative bleeding (r = -0.6, p = 0.0018), more so than platelet count (r = -0.45, p = 0.02), fibrinogen level (r = -0.40, p = 0.06), or prothrombin time (r = 0.43, p = 0.02). The receiver operating characteristic curve c-index describing MA as a predictor for postoperative bleeding is 0.78. Abnormalities in all the laboratory test results were associated with an abnormal MA.


CONCLUSIONS
In conclusion, the kaolin-activated TEG is associated with early coagulopathic bleeding. It may reflect the severity of a global coagulopathy affecting both platelets and coagulation factors and be a guide to incremental prohemostatic therapy in this setting.
Welsby
Ian J
IJ
Department of Anesthesiology, Division of Cardiothoracic Anesthesia and Critical Care Medicine, Duke University Medical Center, Durham, NC 27710, USA. welsb001@mc.duke.edu
Jiao
Kuiran
K
Ortel
Thomas L
TL
Brudney
Charles S
CS
Roche
Anthony M
AM
Bennett-Guerrero
Elliott
E
Gan
Tong J
TJ
D000368:Aged; D000614:Aminocaproates / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D019763:Heparin Lyase / Q000494:pharmacology; D006801:Humans; D007616:Kaolin; D008297:Male; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D019095:Point-of-Care Systems; D019106:Postoperative Hemorrhage / Q000097:blood* / Q000175:diagnosis; D011517:Prothrombin Time; D013916:Thrombelastography
D000614:Aminocaproates; D000933:Antifibrinolytic Agents; D007616:Kaolin; D005340:Fibrinogen; D019763:Heparin Lyase