title: Goal-directed hemostatic therapy using the rotational thromboelastometry in patients requiring emergent cardiovascular surgery.
abstract: OBJECTIVE
  We assessed the clinical impact of goal-directed coagulation management based on rotational thromboelastometry (ROTEM) in patients undergoing emergent cardiovascular surgical procedures.
  
  
  METHODS
  Over a 2-year period, data from 71 patients were collected prospectively and blood samples were obtained for coagulation testing. Administration of packed red blood cells (PRBC) and hemostatic products were guided by an algorithm using ROTEM-derived information and hemoglobin level. Based on the amount of PRBC transfused, two groups were considered: High bleeders (≥5 PRBC; HB) and low bleeders (<5 PRBC; LB). Data were analyzed using Chi-square test, unpaired t-test and analysis of variance as appropriate.
  
  
  RESULTS
  Pre-operatively, the HB group (n = 31) was characterized by lower blood fibrinogen and decreased clot amplitude at ROTEM compared with the LB group (n = 40). Intraoperatively, larger amounts of fibrinogen, fresh frozen plasma and platelets were required to normalize the coagulation parameters in the HB group. Post-operatively, the incidence of major thromboembolic and ischemic events did not differ between the two groups (<10%) and the observed in-hospital mortality was significantly less than expected by the Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM score, 22% vs. 35% in HB and 5% vs. 13% in LB group).
  
  
  CONCLUSIONS
  ROTEM-derived information is helpful to detect early coagulation abnormalities and to monitor the response to hemostatic therapy. Early goal-directed management of coagulopathy may improve outcome after cardiovascular surgery.
authors.forename: Danièle
authors.initials: D
authors.lastname: Sartorius
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Waeber
authors.forename: Gordana
authors.initials: G
authors.lastname: Pavlovic
authors.forename: Angela
authors.initials: A
authors.lastname: Frei
authors.forename: John
authors.initials: J
authors.lastname: Diaper
authors.forename: Patrick
authors.initials: P
authors.lastname: Myers
authors.forename: Tiziano
authors.initials: T
authors.lastname: Cassina
authors.affiliation: Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospital, CH 1211; Faculty of Medicine, University of Geneva, Geneva, Switzerland, .
authors.forename: Marc
authors.initials: M
authors.lastname: Licker
mesh_terms: D000368:Aged; D000465:Algorithms; D001778:Blood Coagulation Disorders / Q000139:chemically induced / Q000628:therapy; D013504:Cardiovascular Surgical Procedures / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006040:Goals; D006487:Hemostasis; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D019990:Perioperative Care / Q000379:methods; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D013916:Thrombelastography / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics