title: Optimization of thromboelastography-guided platelet transfusion in cardiovascular surgery.
abstract: OBJECTIVE
  Platelet dysfunction is a major cause of bleeding complications in patients undergoing cardiovascular surgery under cardiopulmonary bypass (CPB). Thromboelastography (TEG) can be used to assess post-CPB coagulopathy, but its utility in guiding platelet transfusion (PT) after CPB is unclear. This study assessed the utility of a TEG-guided PT protocol in patients undergoing cardiovascular surgery under CPB.
  
  
  METHODS
  The platelet count and TEG maximum amplitude (MA) was measured in 100 patients undergoing valvular or thoracic aortic surgery under CPB. PTs were guided by an empiric protocol in 50 patients (group C) and by a TEG-guided protocol (MA <35 mm, platelet count <7 × 10(4)/mm(3)) in the other 50 patients (group T).
  
  
  RESULTS
  PT was utilized significantly less in group T (11 patients; 22%) than in group C (24 patients; 48%) (P < 0.01). The difference in PT utilization was particularly marked in patients undergoing aortic arch aneurysm repair (20% in group T vs. 100% in group C; P < 0.01), yet there was no difference in bleeding complications between these two groups.
  
  
  CONCLUSIONS
  Use of a TEG-guided transfusion protocol dramatically reduced PT after CPB, particularly in patients undergoing aortic arch aneurysm repair.
authors.affiliation: Department of Cardiovascular Surgery, Niigata Prefectural Shibata Hospital, Shibata, Niigata, Japan. kenjitcs@gmail.com
authors.forename: Kenji
authors.initials: K
authors.lastname: Aoki
authors.forename: Ai
authors.initials: A
authors.lastname: Sugimoto
authors.forename: Ayako
authors.initials: A
authors.lastname: Nagasawa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Saito
authors.forename: Hajime
authors.initials: H
authors.lastname: Ohzeki
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D016009:Chi-Square Distribution; D006801:Humans; D007564:Japan; D016343:Monitoring, Intraoperative / Q000379:methods*; D010976:Platelet Count; D017713:Platelet Transfusion; D011237:Predictive Value of Tests; D013916:Thrombelastography; D014656:Vascular Surgical Procedures / Q000009:adverse effects*