Thromboelastography-based transfusion algorithm reduces blood product use after elective CABG: a prospective randomized study.
OBJECTIVE
Bleeding and allogeneic transfusion remain constant problems in cardiac surgical procedures. In this study, we aimed to test the role of a routine thromboelastography (TEG)-based algorithm on bleeding and transfusions in patients undergoing elective coronary artery bypass grafting (CABG).


METHODS
Patients (n = 224) undergoing elective CABG with cardiopulmonary bypass were prospectively randomized into two groups according to transfusion strategy: in group 1 (clinician-directed transfusion, n = 110) need for blood transfusion was based on clinician's discretion and standard coagulation tests and in group 2 (TEG algorithm group, n = 114) kaolin-activated (k) TEG-based algorithm-guided perioperative transfusion management. Transfusion, blood loss, and outcome data were recorded.


RESULTS
There were no differences in consumption of packed cell units, blood loss, re-exploration for bleeding, and early clinical outcome between the groups. Patients in the TEG group had significantly lower median units of fresh frozen plasma and platelets compared with the other group (p = 0.001). The median number of total allogeneic units transfused (packed cells and blood products) was significantly reduced in the TEG group compared with the other group (median 2, range 1-3 units vs. median 3, range 2-4 units, respectively, p = 0.001). The need for tranexamic acid was significantly diminished in the TEG group compared with the other group (10.3% vs. 19%, respectively, p = 0.007).


CONCLUSIONS
Our results show that routine use of a kTEG-guided algorithm reduces the consumption of blood products in patients undergoing elective CABG. Adopting such an algorithm into routine management of these patients may help to improve clinical outcome and reduce the potential risks of transfusion-related complications and total costs after CABG.
Ak
Koray
K
Department of Cardiovascular Surgery, School of Medicine, Marmara University, Istanbul, Turkey. akkoray@hotmail.com
Isbir
Cemil S
CS
Tetik
Sermin
S
Atalan
Nazan
N
Tekeli
Atike
A
Aljodi
Maher
M
Civelek
Ali
A
Arsan
Sinan
S
D000368:Aged; D000465:Algorithms; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D016913:Blood Component Transfusion / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D013916:Thrombelastography; D014148:Tranexamic Acid / Q000627:therapeutic use
D000933:Antifibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D014148:Tranexamic Acid; D001241:Aspirin