title: The kaolin-activated Thrombelastograph predicts bleeding after cardiac surgery.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Division of Cardiothoracic Anesthesia and Critical Care Medicine, Duke University Medical Center, Durham, NC 27710, USA. welsb001@mc.duke.edu
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Welsby
authors.forename: Kuiran
authors.initials: K
authors.lastname: Jiao
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Ortel
authors.forename: Charles S
authors.initials: CS
authors.lastname: Brudney
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Roche
authors.forename: Elliott
authors.initials: E
authors.lastname: Bennett-Guerrero
authors.forename: Tong J
authors.initials: TJ
authors.lastname: Gan
mesh_terms: 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
chemical_list: D000614:Aminocaproates; D000933:Antifibrinolytic Agents; D007616:Kaolin; D005340:Fibrinogen; D019763:Heparin Lyase