title: Change in hemostatic intervention after implementation of thromboelastometry.
abstract: OBJECTIVE
  To monitor the use of blood products and hemostatic intervention after implementation of thromboelastometry.
  
  
  METHODS
  Observational prospective study using a historic control.
  
  
  METHODS
  Single-center university hospital.
  
  
  METHODS
  Patients undergoing cardiac surgery during 2008 (n = 811) were compared with similar patients in 2009 (n = 865).
  
  
  METHODS
  Thromboelastometry was implemented in December 2008. Changes in transfusion of blood products and changes in use of recombinant factor VIIa and fibrinogen were studied.
  
  
  RESULTS
  Use of blood products was not decreased significantly after implementation of thromboelastometry. However, in patients receiving blood products, the units of red blood cells were decreased significantly (p = 0.04). Regarding hemostatic reagents, the use of recombinant factor VIIa was decreased significantly (p = 0.04), and the use of fibrinogen increased significantly (p < 0.001). Most blood products (>70%) were given to a minority of patients (∼10%) in 2008 and 2009. In 2009, thromboelastometry was performed in 146 patients (17%), and the use of blood products (p < 0.0001), recombinant factor VIIa (p < 0.001), and fibrinogen (p < 0.001) was significantly higher compared with patients in whom thromboelastometry was not performed.
  
  
  CONCLUSIONS
  After implementation of thromboelastometry, the use of recombinant factor VIIa was decreased significantly, whereas the use of blood products was not decreased significantly in patients undergoing cardiac surgery.
authors.affiliation: Department of Clinical Biochemistry, Aarhus University Hospital, Skejby, Denmark. am.hvas@dadlnet.dk
authors.forename: Anne-Mette
authors.initials: AM
authors.lastname: Hvas
authors.forename: Tue Wincentz
authors.initials: TW
authors.lastname: Boas
authors.forename: Malene
authors.initials: M
authors.lastname: Jensen
authors.forename: Christian
authors.initials: C
authors.lastname: Lindskov
authors.forename: Lars
authors.initials: L
authors.lastname: Folkersen
authors.forename: Hanne Berg
authors.initials: HB
authors.lastname: Ravn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation / Q000187:drug effects / Q000502:physiology; D001802:Blood Substitutes / Q000008:administration & dosage; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D015942:Factor VIIa / Q000008:administration & dosage; D005260:Female; D006487:Hemostasis / Q000187:drug effects / Q000502:physiology*; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage; D013916:Thrombelastography / Q000379:methods*
chemical_list: D001802:Blood Substitutes; D006490:Hemostatics; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa